The number of outpatient attendances in England is now approaching 100 million each year.[1] In 2017/18, the estimated cost of this care was over £9 billion – or 8% of the total NHS England budget. So, isn’t it strange how little we know about outpatient activity and, in particular, the purpose, or function, of appointments?   Without this knowledge, we will surely struggle to ensure that the billions spent on outpatient services are delivering the best value for the patient, and for the public.

Having started from this observation, the Midlands Decision Support Network (MDSN) asked the Strategy Unit (which acts as its development centre) to create a new classification system for outpatient activity – one that would examine activity from the perspective of function, one that might be used to address real-world strategic questions.  This report therefore details the development of a set of rules that categorise outpatient attendances according to their implied function. The report goes on to examine the types of question that such a system can help address.

The report differs from our typical contributions to the Midlands Decision Support Network in that it offers a method, and a rationale for that method, rather than a set of analytical outputs. This is because the method lends itself to such a wide variety of questions, no single report could do justice to them all. Instead, we invite MDSN members (and the rest of the NHS) to test this method in practice. We hope that they will share –  with each other, and with us – the new insights that it provides about this hugely significant area of health service activity.

[1] Hospital Outpatient Activity 2019-20. NHS Digital (2020)