What is the cost of outpatient appointments?

Face-to-face outpatient appointments require patients to take time off work, travel and organise childcare. This all has a cost to the economy. Earlier this year we sought to calculate the impact on productivity of outpatient appointments by looking at the time working people needed to take off work, and also the cost to the NHS in missed appointments. We tackle the issue in this month’s data briefing from the ZPB analytics unit. Here’s what we discovered:

Key findings:
1. £231 million is lost to the economy due to time taken off work for outpatient appointments
2. 4,920,000 clinician hours could be saved if outpatient appointments are made digital
3. £266 million could be saved by reducing ‘Do not attend’ rate for outpatient appointments to 2%

Our methodology:

We used a variety of data sources with the aim of quantifying the loss to the economy that occurs as a result of people taking time off work to attend an outpatient appointment. Annual outpatient statistics from NHS Digital gave us the number of actual attendances, not just appointments, for outpatients. We assumed that 30% of these attendances could be done remotely but a small number of attendances were already telephone consultations, so we subtracted them from the total number of attendances that could be moved to digital to account for that. Based on the age distribution in the total number of attendances we assumed that 54% of all potential digital attendances refer to people between the age of 16-64. Using ONS employment statistics, we calculated how many of those appointments would be for people in employment. We further investigated how many hours could be saved in clinicians’ time by switching 30% of all outpatient appointments to virtual consultation by comparing the average time for conventional face-to-face appointments (20 minutes) to an average time of 12 minutes using data from ZPB client Visiba.

The analysis revealed that 10.6 million attendances that could be moved online relate to people in employment. If 20% of full-time employment and 10% in part-time employment have to take half a day off work, that equates to almost one million full days of work that are lost due to outpatient attendances that could be done digitally and therefore would not require time off work. We valued that at a total of £231 million that are lost to the economy because people take time off work.

We complemented this analysis with further modelling of the hours of clinicians’ time that could be saved by using digital appointments, which take less time than face-to-face appointments, and how much can be saved due to reduced number of DNAs (did not attend). Almost five million clinician hours could be saved if 30% of outpatient appointments moved to virtual consultations with organisations such as Visiba or Digital Healthcare Council members Babylon, Livi and Push Doctor. The analysis also revealed that conventional face-to-face outpatient appointments cost £354,240,000 in DNAs for 30% of all appointments that are suitable for a virtual consultation. With a 2% DNA rate, this could be reduced to £88,560,000, saving £265,680,000 a year.

Chart 1: Showing the difference in cost and time per outpatient appointment done face-to-face compared to a digital outpatient solution, emphasising the reduction in DNA rate and cost, as well as saving clinicians’ time.

Why is this important?

The NHS Long Term Plan outlines the aim to redesign outpatient services to enable digital appointments, and in phase 2 of the NHS response to COVID-19, Sir Simon Stevens emphasised the importance of taking this opportunity to ‘lock-in’ beneficial changes, including rapid scaling of new technology-enabled service delivery options.

What was the impact?

The analysis was covered by The Telegraph, which highlighted the total impact that moving one in three outpatient appointments to virtual consultation.

Datasets used:

The analysis was based on NHS Digital figures for Outpatient Hospital Activity for 2018/19 to determine the number of outpatient attendances. Employment rate statistics were taken from ONS and OECD. The gross value add for an hour of work was taken from ONS. DNA rate for conventional face-to-face appointments was estimated from NHS Statistics Quarterly Hospital Activity.

Authors: Anne Janssen and Alex Kafetz from the ZPB analytics unit

The ZPB analytics unit is part of ZPB Associates and works alongside ZPB’s strategy, marketing and PR specialists to combine bespoke analysis, understand of available data and statistical, health data and economic techniques to bring rigour, insight and value measurement to client challenges. This includes data-led PR stories, market analysis and segmentation, understanding the value of products and services if rolled out at scale and the economics and societal consequences of a policy being enacted. We have completed analysis for pharma companies, technology businesses and private providers of NHS services. We passionately believe that data adds another dimension to a story. It provides insight, legitimacy, enhancing your message creating impact and important context. It always needs to be handled with responsibility and integrity and that’s what we know how to do– using data to stand up a story that’s not valid is wrong – and ultimately damages your brand.

To understand how your organisation can work with the ZPB analytics unit please speak to Alex Kafetz, via or 07826 552349

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