The way hospitals in the UK run outpatient clinic appointments is stuck "in the 18th Century", leading doctors say.
Every year millions of people travel to hospitals, where doctors check up on their health and discuss their care.
The Royal College of Physicians said many appointments were unnecessary – and outdated, inefficient systems meant large numbers were missed or cancelled.
It said the situation was frustrating for patients, and wasting money.
The RCP's report said the time had come to overhaul the system by embracing innovation: making more use of remote monitoring and telephone and video consultations.
Getting other staff, such as senior nurses, to run clinics closer to people's homes could also help.
It said a number of places had already started taking these steps, but much more needed to be done.
Dr Toby Hillman, of the RCP, said: "It's an 18th Century system. It should not be beyond us to tackle this."
What are outpatient appointments?
Outpatient departments are the busiest part of hospitals in terms of the numbers seen.
Last year there were 127 million appointments in the UK – nearly five times more than the numbers who came to A&E.
Patients come in to discuss their health as part of their ongoing care, or may see their doctor to discuss their recovery from surgery. or before they go under the knife.
The report pointed out these appointments can require a significant amount of time, cost and planning for patients because of things like travel, missing work and arranging childcare.
But in England one in five appointments is cancelled, or patients do not turn up.
Some of the cancellations are unavoidable, because of sickness or emergencies requiring staff to be deployed elsewhere.
But the RCP said the majority could be avoided if there were better systems in place.
How the system breaks down
There are a number of reasons why the service does not work smoothly.
Doctors surveyed – there were nearly 1,400 polled in compiling the report – said some appointments had to be cancelled because the results of tests were not yet available. or scans had not been booked in time.
One consultant described his experience of outpatient departments as "shocking", complaining of missing notes and results.
In cases where patients did not turn up, the report said there was evidence that they had tried to alert the hospital but there was not an efficient system in place to record the information.
The report said hospitals were also struggling to cope with demand – the number of appointments has doubled in the past decade.
This combination of inefficiency and sheer volume contributed to large numbers of appointments – 57% – running late.
How many appointments are unnecessary?
Doctors were asked if they felt a significant minority of outpatient appointments – between 10% and 20% – could be avoided.
One in four said this proportion of new patient appointments was simply not needed.
A similar number said this proportion of follow-up appointments could be avoided by using alternative methods, such as video consultations.
If the number of cancelled and missed appointments was reduced, this could also provide a significant saving.
But the RCP warned the system of funding hospital care needed to change.
Hospitals are paid per patient seen, so could find themselves penalised if they reformed the system.
NHS England medical director Prof Stephen Powis said doctors were just as frustrated as patients about the "antiquated" processes.
He said the issue would be tackled as part of the NHS long-term plan that is currently being developed so the outpatient service could be brought into the "21st century".
"The time has come to grasp this nettle," he added.
NHS ‘should not prescribe acne drug’
The parents of young people who have killed themselves and patients unable to have sex are calling f..
The parents of young people who have killed themselves and patients unable to have sex are calling for the NHS to stop prescribing acne drug Roaccutane.
Ed Henthorn said it had caused him erectile dysfunction, psychosis and suicidal thoughts.
And one man who believes his son killed himself after taking the drug said the risks "are just too high".
Manufacturer Roche said "millions of patients worldwide have benefited from taking the drug".
The majority of those who take the drug have a positive experience.
"I used to think about girls… but my feelings, thoughts, just faded away," Ed Henthorn told the BBC's Victoria Derbyshire programme.
He was 19 when he took Roaccutane. He describes his acne as mild but bad enough to want to treat.
After three weeks he started to experience side-effects, including reduced energy and sex drive.
Then he experienced erectile dysfunction.
"That was why I decided to stop taking it," he said. (more…)
Spina bifida: Keyhole surgery repairs baby spine in womb
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In a UK first, doctors have used keyhole surgery to su..
In a UK first, doctors have used keyhole surgery to successfully repair the spine of a baby with spina bifida while it was still inside the womb.
Surgeons at King's College Hospital say the procedure is not a cure, but could be the difference between some children learning to walk or not.
Sherrie Sharp and her son Jaxson had the operation 27 weeks into the pregnancy.
Spina bifida was diagnosed after the routine 20-week pregnancy scans.
They showed Jaxson's spine and spinal cord were not forming correctly.
Gaps in the developing spine meant the cord was bulging out of his back and was left exposed to the amniotic fluid in the womb.
This damages the crucial nerves in the spinal cord and could lead to paralysis, a loss of sensation in the legs and problems controlling the bladder and bowels.
The longer the spinal cord is left exposed, the greater the damage.
Sherrie, 29, and from West Sussex, said the news was a shock, but an abortion was a "definite no". (more…)
Less chemotherapy better for older or frail patients with advanced stomach and oesophageal cancers
Less chemotherapy is as effective at controlling disease for elderly or frail patients with advanced..
Less chemotherapy is as effective at controlling disease for elderly or frail patients with advanced cancer of the stomach or oesophagus (food pipe), and leads to fewer side effects such as diarrhoea and lethargy. These are the results of a Cancer Research UK funded study, presented prior to the ASCO conference today (Wednesday).
“Increasingly were realising its not just age that affects how well someone can tolerate their treatment and we need to do more work to understand how other conditions or aspects of frailty might play a role.” – Dr Peter Hall, Cancer Research UK Edinburgh Centre[contfnewc]
Results from the GO2 trial could change the standard of care for patients who cant have full dose chemotherapy due to their age, frailty or medical fitness.
The study, which ran at hospitals all over the UK, coordinated from the University of Leeds, involved 514 people with stomach or oesophageal cancer. Their average age was 76 and the oldest was 96 years old. All were either frail, elderly or medically unfit, and for those reasons would be unlikely to tolerate full-strength treatment, which involves three chemotherapy drugs.
Patients went through a careful medical assessment, then went onto chemotherapy with just two drugs* and were allocated at random to receive them at either full-strength, medium-dose or low-dose. They were then carefully monitored to see how well the cancer was controlled, whether they had symptoms and side-effects, whether they felt their treatment was worthwhile, and what overall effect it had on their quality of life.
The researchers reported that the medium and lower doses of chemotherapy were as effective as the full-strength dose for controlling the cancer. But when the researchers looked at the overall effect of treatment, including quality of life, they reported that it was the lowest dose treatment that came out best.**
Around 15,800 people in the UK are diagnosed with stomach and oesophageal cancers every year***. Almost half (45%) of these people are 75 and over****. By 2035, this proportion is projected to rise to 55%*****, because of the UKs ageing population. This study, is one of few phase III trials in the country that seek to address how to best care for and treat this increasing population of elderly or frail cancer patients.
These findings also open up the possibility of more older and frail patients being able to take part in clinical trials.
Professor Charles Swanton, Cancer Research UKs chief clinician, said: “These valuable results reduce fears that giving a lower dose chemotherapy regimen is inferior and could make a huge difference for patients with stomach or oesophageal cancer who cant tolerate intensive courses of treatment.
“Older or frail patients are often not considered for new drug trials or standard of care therapy as theyre less able to tolerate combination chemotherapy. These trials are critical to provide much needed evidence on the effectiveness of new therapies and combination approaches, helping us develop new treatments for this growing group of patients.”
The researchers also assessed whether there were differences for the patients in the study who were under 75, or less frail, who might be expected to benefit from stronger treatment; but will be reporting that the lowest dose treatment gave the best results for them as well. (more…)
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