Patients called it first: why it’s time to tear up the outpatients model

When Sir Jim Mackey, Chief Executive of NHS England, stood on stage at NHS ConfedExpo last week and declared that the NHS must “tear up” the model of providing outpatients, he captured in a few short words what patients have been telling us for years. 

At the heart of his comments was a call for “big leaps”; a fundamental rethink of outdated tech, clunky communication, and repetitive admin that adds no value. Our extensive patient engagement programme, delivered in partnership with the Royal College of Physicians (RCP), offers the evidence that backs up his call and shows how transformation can and must happen. 

Drawing on insights from patient panels, a national survey, and participation in clinical summits, the final report presents a clear message: many patients feel disconnected from a system that should be working with them, not around them. 

What patients told us 

Patients described appointment systems that are hard to navigate, communications that lack clarity or warmth, and care pathways that prioritise process over people. Their experiences mirror the concerns raised by Sir Jim Mackey, particularly around ineffective technology, fragmented journeys, and unnecessary duplication. For many, these aren’t abstract frustrations but daily realities that leave them feeling excluded and disempowered in their own care. 

At best, these communication failures created irritation. At worst, they would have contributed to missed appointments, delayed treatment, and poor health outcomes. Better communication isn’t a “nice to have”, it’s central to safe, efficient, equitable care. It’s also the key to solving the inefficiencies Sir Jim Mackey described. 

These issues aren’t new. Our separate project on referral to treatment times raised similar concerns, demonstrating this is a systemic issue requiring fundamental transformation, not incremental fixes. 

Our joint “Prescription for outpatients” 

The principles set out in our joint report with the RCP, Prescription for Outpatients, outline a smarter, more inclusive future for outpatient care: 

• Timely care: Patients seen by the right person, in the right place, at the right time 

• Patient power: Shared decision-making and self-management, not paternalistic care 

• Seamless integration: Joined-up communication between patients and professionals 

• Effective delivery: Reducing unnecessary appointments and valuing people’s time 

• Data-led prioritisation: Technology that works for patients and tackles inequalities 

• This is not a distant aspiration. It’s an achievable goal—if we act now. 

So, what can be done? Our report proposed immediate-impact interventions, including: 

• Supporting patient preparedness for outpatient care through education and tailored resource 

• Embedding “What matters to you?” conversations to shape personalised care plans 

• Improving communication materials to be clear, accessible and available in multiple formats and languages 

• Integrating shared digital care plans across services 

• Developing a refreshed long-term workforce strategy to meet rising patient demand 

• Reforming commissioning models to incentivise joined-up, patient-centred approaches. 

The foundations for change are already in place, and patients have made it clear that they are ready for a different approach. What is needed now is a commitment to meaningful, system-wide action. We must build a system that works not only for patients, but in true partnership with them.