The One Devon Elective Pilot Programme started in January 2023 following some deep dive visits and recommendations from the national Get It Right First Time (GIRFT) team. The case for doing things differently was clear to the team as they had significant challenges in elective recovery and faced capacity and demand challenges across the system.
The pilot programme was designed to improve productivity and significantly reduce waiting times for patients whilst improving equity of access, clinical quality, outcomes, and experience for patients across Devon.
The focus was initially on orthopaedic, ophthalmology and spinal surgical services, working closely with acute provider specialty teams.
Action taken
A GIRFT team approach was taken to drive a culture change for surgical teams across the NHS in Devon to work differently and to maximise activity within clinic and theatre times which could enable as much work as possible to take place in day case settings, and to ensure surgeons can work across multiple hospital sites to maximise the use of all of Devon's theatres.
The scope of the programme was kept quite tight with four to five deliverables for each specialty and a system clinical lead was appointed for each specialty who built relationships with their peers across the system.
There was an emphasis on good governance with clear lines of accountability, alongside fortnightly meetings for clinical and operational leads for each specialty, which required commitment, engagement and investment from those involved in the programme. There was also a fortnightly assurance programme board including key senior leaders from each organisation.
Outcomes and impact
Through the creation of a single point of access and the sharing of best practice across Devon, the programme helped to reduce the number of spinal service patients with over 78 week waits from 145 to four patients between May 2023 and April 2024.
The orthopaedics programme supported surgeons from across Devon to spend time working within the South West Ambulatory Orthopaedic Centre environment which helped to increase productivity and reduce patients' length of stay and consequently waiting lists.
The ophthalmology programme saw real improvements in their productivity. In 2022 only 16% of high-volume low complexity cataract activity was taking place in the NHS provided services, but by 2024 all units had improved their waiting times position for simple cataracts and increased their number of lists and productivity and significantly reduced their glaucoma service backlog.
The One Devon Elective Pilot Programme involves the One Devon integrated care board, the GIRFT team and the acute providers in the One Devon integrated care system. See further detail on this programme here.