Intended for healthcare professionals

Observations The Best Policy

Reducing outpatient activity does not cut costs

BMJ 2018; 361 doi: (Published 26 April 2018) Cite this as: BMJ 2018;361:k1826
  1. Nigel Edwards, chief executive, Nuffield Trust, London, UK
  1. nigel.edwards{at}

This flawed approach has led to wasted effort in passing financial problems around the system

Each year in England there are more than 110 million outpatient appointments. The number has been rapidly growing, particularly since 2008.

Many of the NHS’s sustainability and transformation plans, intended to transform health and care in 44 areas across England,1 have incredibly ambitious proposals to cut costs by reducing outpatient activity. Cheshire and Merseyside, for example, hopes to save £22.5m (€26m; $31m) by reducing referrals by 20%.2 Leicester, Leicestershire, and Rutland intends to reduce all outpatient activity by 30% by moving services into the community,3 and Durham, Darlington, and Tees hopes to achieve a 20% cut in outpatient activity.4

Such ambitions present several problems.

For instance, the prices quoted for outpatient activity (with new appointments ranging from £95 to almost …

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