In partnership with the Patients Association, the Royal College of Physicians (RCP) has launched Prescription for outpatients: reimagining planned specialist care, setting out our vision for reformed outpatient care.
The current model of outpatient care is outdated, inefficient, and in need of reform. Over 135 million outpatient appointments in 2023–24 were often associated with delays, poor communication, and confusion caused by trying to navigate services.
Following extensive engagement with patients, healthcare professionals and NHS England, the RCP is now calling on the UK government to put outpatient reform at the centre of the 10-Year Health Plan, with the funding and resource to make the system work for patients and clinicians.
Outpatient care is a vital part of the NHS, where patients will receive planned clinical investigations and tests, treatment and potentially life-changing diagnoses.
The RCP’s call for outpatient reform comes in response to Lord Darzi’s 2024 independent review which highlighted rising NHS waiting times for planned care.
The need for care through outpatient services has grown year on year – a trend that is predicted to continue as the population ages and more people live with multiple health conditions. These trends have contributed to growing waiting lists, with the majority of people currently on NHS waiting lists in England needing an outpatient appointment rather than an operation.
Senior doctors are now advocating for a shift towards prevention and early intervention, timely care closer to home and flexible, multidisciplinary integrated care pathways working across the healthcare system. The RCP vision sets out five ambitions for outpatient care:
- timely care by the right person, in the right setting
- empower patients through personalised care
- improve mechanisms for communication across professionals and with patients
- use innovative models to make the most of time spent with patients
- harness data and technology to reduce inequalities and prioritise need.
In a 2025 snapshot survey of RCP members, 57% said they did not have adequate resource to deliver outpatient activity remotely. More than two thirds (66.8%) of physicians said their ability to deliver outpatient care was limited by the availability of rooms, while fewer than a third (31.2%) of respondents said they have the time and information needed to prioritise patients on follow up waitlists based on their risk.
Dr Theresa Barnes, RCP clinical lead for outpatients said:
‘NHS outpatient care is fundamentally no longer fit for purpose. It is archaic, disjointed and ultimately ineffective for both patients and staff.
‘It has remained largely unchanged for decades, despite advances in technology. Most people on NHS waiting lists are waiting for an outpatient appointment, patient care is increasingly complex, and the medical workforce is frustrated and desperate for change.
‘Our new report, “Prescription for outpatients” draws on the ideas and expertise of doctors and patients to embrace a new way of doing things – prioritising people, rather than the system. We need a significant shift in the way we deliver planned specialist care. Getting this right is integral to bringing down NHS waiting lists and delivering the government’s three shifts. Now is the time to be radical.’
Outpatient care has historically been used to describe care delivery in a particular setting or location, where patients consult doctors who give specialist advice and treatments.
The RCP’s new report redefines the full extent of NHS outpatient, or planned specialist care, describing eight transformational shifts in the way it is delivered – including moving from a ‘one size fits all’ approach to personalised care; from siloed teams to integrated pathways; and from activity-counting to outcome-focused care – underpinned by five enablers:
- digital tools and technology
- education and training
- coding and data
- commissioning and funding models
- workforce.
Rachel Power, chief executive of the Patients Association said:
‘Too many patients tell us that outpatient care feels like an uphill battle, with delays, confusion, and a lack of joined-up communication that leaves them feeling powerless. Our joint report with the Royal College of Physicians marks an important step towards the kind of reform patients have long been calling for. Planned specialist care must be built around the needs of real people, not rigid systems.
‘With the upcoming implementation of the 10-year health plan, the use of technology to improve access, reduce inequalities, and support people to manage their own care is vital. Outpatient services should implement our six key principles of patient partnership, to ensure it works with patients. This vision lays out a roadmap to get us there.’
People living with multiple health conditions also use outpatient services more. A patient with four or more health conditions will need more than three times as many outpatient appointments as someone with only one health condition. [1]
With almost 1 in 5 (17%) people over the age of 65 expected to live with four or more long-term health conditions by 2035 [2], the RCP says that reform of planned specialist care is vital to reduce waiting lists and must be part of the government’s 10-year plan for health.
The RCP Prescription for outpatients provides a 10-year roadmap with over 40 recommendations for patients, clinicians, governments, charities, professional bodies and the NHS.
To successfully deliver reformed planned specialist care, the RCP is calling on government and the NHS to expand the specialist workforce, increase medical school and postgraduate training capacity and ensure that doctors and healthcare professionals are supported with adequate administrative support and digital infrastructure.
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A study from the Health Foundation published in 2018 found that over a two year period, patients with over four health conditions had an average of 8.9 outpatient visits across 2.8 different medical specialties. This compared to 2.8 outpatient visits for patients with one condition.
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The projection for 17% of people over the age of 65 living with four or more long-term health conditions by 2035 was published in this paper: Kingston A, Robinson L, Booth H, et al. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018.