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National

Dashboard > Managing First Follow Up


 

First follow up ratio 1.90
Opportunity £297,203,454
Volume Opportunity 2,814M
Rank 1

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Treatment Function First follow up ratio Financial Opportunity Volume Opportunity Rank
Ophthalmology 3.02 £24,324,118 297,918 1
Clinical Oncology (previously Radiotherapy) 7.60 £22,658,219 200,067 1
Cardiology 1.39 £20,685,101 177,829 1
Trauma & Orthopaedics 1.69 £16,433,030 196,113 1
Clinical Haematology 6.72 £12,254,279 96,560 1
Urology 2.03 £11,602,587 85,296 1
Nephrology 7.51 £11,174,711 82,709 1
Medical Oncology 8.20 £9,532,306 83,309 1
Gynaecology 1.05 £9,460,191 84,777 1
General Surgery 1.33 £9,394,203 96,362 1
Paediatrics 1.16 £8,756,830 63,948 1
Respiratory Medicine (Thoracic Medicine) 2.06 £8,409,285 74,850 1
Rheumatology 3.88 £8,094,693 76,524 1
Diagnostic Imaging 0.47 £8,079,550 124,168 1
Dermatology 1.74 £7,097,633 85,902 1
Ear, Nose & Throat (ENT) 1.30 £6,572,382 74,562 1
Gastroenterology 1.82 £6,464,456 57,706 1
Diabetic Medicine 5.32 £5,971,707 59,689 1
General Medicine 1.17 £5,734,382 50,582 1
Pain Management 2.18 £5,381,589 48,884 1
Plastic Surgery 2.23 £5,048,849 63,369 1
Orthodontics 9.72 £4,833,474 42,668 1
Breast Surgery 1.04 £4,056,214 37,428 1
Respiratory Physiology 1.57 £3,711,563 24,079 1
Geriatric Medicine 1.31 £3,302,516 23,957 1
Oral Surgery 1.16 £3,195,318 33,105 1
Paediatric Ophthalmology 2.31 £3,047,005 34,376 1
Endocrinology 2.84 £3,031,497 30,913 1
Infectious Diseases 2.99 £2,928,279 14,021 1
Vascular Surgery 1.31 £2,784,572 24,898 1
Colorectal Surgery 1.06 £2,783,456 31,855 1
Hepatology 4.39 £2,778,171 24,484 1
Anaesthetics 1.43 £2,715,745 38,706 1
Restorative Dentistry 4.63 £2,354,996 18,094 1
Maxillo Facial Surgery 1.39 £2,323,761 25,940 1
Clinical Physiology 0.81 £2,147,467 13,491 1
Paediatric Cardiology 1.87 £2,135,852 13,350 1
Paediatric Trauma and Orthopaedics 1.41 £2,042,281 20,044 1
Paediatric Clinical Haematology 6.97 £1,496,442 7,196 1
Gynaecological Oncology 1.51 £1,393,046 13,185 1
Audiology 0.64 £1,271,129 10,870 1
Paediatric Respiratory Medicine 2.52 £1,184,452 7,739 1
Paediatric Endocrinology 3.58 £1,172,352 6,214 1
Paediatric Surgery 1.11 £1,103,242 9,946 1
Cardiac Surgery 1.70 £1,043,927 5,808 1
Paediatric Dentistry 2.06 £999,745 6,495 1
Paediatric Gastroenterology 2.87 £960,603 6,373 1
Cardiothoracic Surgery 1.47 £895,911 5,067 1
Medical Ophthalmology 6.05 £883,435 7,327 1
Spinal Surgery Service 1.84 £875,741 8,560 1
Thoracic Surgery 2.11 £802,474 4,703 1
Upper Gastrointestinal Surgery 1.23 £800,347 9,356 1
Paediatric Urology 1.46 £787,027 5,268 1
Paediatric Plastic Surgery 1.88 £686,926 6,458 1
Paediatric Dermatology 1.71 £686,473 7,108 1
Paediatric Diabetic Medicine 21.41 £617,580 6,240 1
Paediatric Ear Nose and Throat 1.29 £586,656 7,919 1
Hepatobiliary & Pancreatic Surgery 2.31 £531,846 4,171 1
Obstetrics 1.16 £452,076 2,808 1
Neurology 0.50 £443,449 2,222 1
Audiological Medicine 0.64 £430,274 3,717 1
Podiatry 8.51 £407,311 3,244 1
Physiotherapy 4.27 £389,874 2,210 1
Midwife episode 1.89 £366,592 2,624 1
Dental Medicine Specialties 1.72 £355,653 2,842 1
Orthoptics 3.32 £326,734 2,980 1
Paediatric Epilepsy 4.00 £263,810 1,551 1
Clinical Neurophysiology 0.06 £260,690 1,344 1
Neurosurgery 14.02 £187,538 1,160 1
Paediatric Maxillo-facial Surgery 1.49 £168,983 1,267 1
Paediatric Clinical Immunology and Allergy 1.08 £139,949 888 1
Optometry 1.56 £114,852 953 1
Interventional Radiology 0.14 £112,712 412 1
Burns Care 5.55 £106,198 880 1
Congenital Heart Disease Service 2.92 £84,727 519 1
Allergy 0.28 £73,163 516 1
Community Paediatrics 2.34 £65,317 421 1
Clinical Pharmacology 2.21 £53,212 309 1
Paediatric Medical Oncology 16.86 £50,929 245 1
Accident & Emergency (A&E) 0.81 £45,347 280 1
Occupational Therapy 0.76 £39,973 286 1
Paediatric Audiological Medicine 1.32 £34,671 318 1
Transplantation Surgery 8.00 £26,015 188 1
Paediatric Burns Care 1.99 £20,297 167 1
Clinical Immunology & Allergy 0.47 £20,142 123 1
Speech and Language Therapy 2.29 £12,206 112 1
Transient Ischaemic Attack 0.01 £9,643 97 1
Rehabilitation 0.46 £9,228 48 1
Bone & Marrow Transplantation 5.88 £8,643 47 1
Cardiac Rehabilitation 3.13 £8,378 50 1
Anticoagulant Service 0.92 £7,216 45 1
Programmed Pulmonary Rehabilitation 0.48 £7,073 43 1
Dietetics 1.22 £5,940 39 1
Stroke Medicine 0.10 £2,771 17 1
Neonatology 0.08 £2,756 17 1
Clinical Immunology 0.29 £2,048 14 1
Paediatric Neurology 0.50 £1,739 11 1
Chemical Pathology 0.53 £1,467 9 1
Orthotics 1.25 £545 5 1
Clinical Genetics 0.33 £109 1 1
Nuclear Medicine 0.02 £109 1 1
Cardiothoracic Transplantation 2.30 - 0 1
Clinical Microbiology - - 0 1
Clinical Psychology 2.22 - 0 1
Critical Care Medicine - - 0 1
Genitourinary Medicine 0.30 - 0 1
Paediatric Cardiac Surgery 2.36 - 0 1
Paediatric Infectious Diseases 2.00 - 0 1
Paediatric Nephrology - - 0 1
Paediatric Neuro-disability - - 0 1
Paediatric Neurosurgery - - 0 1
Paediatric Rheumatology - - 0 1
Palliative Medicine - - 0 1
Tropical Medicine 0.09 - 0 1

Each year in the NHS there are ‘follow-up’ appointments where patients are asked to return to hospital to have their progress checked, to undergo tests, or to get test results. Whilst some of these appointments are clinically required, a large proportion are unnecessary. Reducing unnecessary follow-up appointments releases capacity for the treatment of new patient referrals.

This indicator looks at the ratio of follow-up appointments in relation to first appointments. A relatively high ratio could indicate that too many follow up appointments are taking place. It can assist trusts in ensuring that they achieve best practice in the level of new to follow-up appointments.

The indicator measures the number of outpatient follow up attendances that took place against the number of outpatient first attendances that took place. This includes Consultant, Nurse, Midwife, and other Care Professionals attendances, including Ward Attendances for nursing care

Follow-up does not have to mean that a patient is physically present with a healthcare professional. Telephone calls, questionnaires, web based services and group visits could be used to replace the traditional visit.

Follow-up appointments after treatment should take place in the right healthcare setting and be delivered by the appropriate healthcare professional. This means investigating alternatives to a consultant led hospital-based outpatient appointment. The first question should be “is a follow-up visit really necessary?” If it is, the assumption should be that the follow-up can be performed in a primary care setting and should be instigated by the patient. Automatic secondary care follow-up should be used only where necessary and clinically appropriate.

Key steps :

  • Analyse your new-to-return ratios and DNA rates to identify where these are out of line with the expected levels.
  • Agree changes to clinical practices and processes to bring new-to-return ratios for all specialties in line with expected national performance and local standards.
  • Use techniques such as telephone follow-up to eliminate the need for return appointments in the hospital.
  • Monitor follow-up ratios by specialty and report this to the board on a regular basis.

Further Information

NHS Elect – Service Transformation Tools

http://www.nhselect.nhs.uk/Service-Transformation

Information Shown

This indicator shows the opportunity for reducing the ratio of first and follow up outpatient appointments for providers. The productivity opportunity is calculated by applying the first follow up (FFU) ratio of the 10th, 25th or 50th percentile provider to the number of first attendances and applying the average follow up attendance tariff. Organisation Dashboard The following information is displayed for Managing New to Follow Up Outpatient Appointments. First to Follow Up Ratio - Calculated ratio for the trust or treatment function Financial Opportunity - The financial opportunity based on the quarter performance. Multiply by 4 to calculate annualised opportunity. Volume Opportunity - Potential adjustment in attendance Rank - Rank calculation based on first to follow up ratio within combinations of organisation type or Treatment Function and quarter of data.

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