Beyond Covid – Evolving the Parkinson’s outpatient service in NHS Fife

The aim of this project was to evaluate how we might evolve the outpatient older adults Parkinson's service to provide outpatient care to patients when they want and how they want, considering both clinician and patient attitudes.

Two initial interventions were considered:

1. Patient initiated review (PIR). – Rather than scheduling a future outpatient appointment in advance (eg 9 months time) selected patients would be enrolled onto a PIR pathway, they would then be able to request appointment at a point when they wanted review.

2. Virtual Consultation – these were used frequently during Covid19 and we considered ongoing use of telephone and/or video consultation (using NHS NearMe platform), possibly in blended in person/virtual clinics.

Phase 1 of the project, reported here, evaluated clinician attitudes to both of these interventions

Results

Virtual Consultation

60% of the team had used both telephone and video consultations previously. All would be interested in using virtual consultation for some patients post pandemic. 60% felt patient selection should be made jointly by clinician and patient. Nobody felt that it should be clinician only decision. 80% would be willing to consider a mixed clinic where some patients were seen in person and others virtually.

Patient Initiated Review

All of the team were interested in using PIR for some patients, 80% preferred setting a time limit ‘ceiling’ on how long a patient could go without review. 60% preferred a limit of 12-18 months. Nobody opted for >2 years.

There was a general openness from clinicians to using both PIR and virtual consultations but with a preference for careful patient selection and involvement of patients themselves. Service development benefits were less likely to be considered by clinicians.