2. Elective recovery as a system effort through transforming access and pathways

One of the clearest areas of value is elective and diagnostic recovery, where collaboratives have been able to act quickly, align providers, and redesign care pathways.

In the South East London acute provider collaborative, which is made up of three NHS trusts and was established during the early stages of the COVID-19 pandemic when elective backlogs were mounting rapidly, rather than focusing solely on increasing activity the collaborative took a different approach by redesigning pathways at the point of entry into the system.

Ophthalmology was one of the most challenged specialties.  The collaborative’s ophthalmology network, which is one of seven elective specialty-based clinical networks, introduced a single point of access model in ophthalmology with initial triage delivered by optometrists. This fundamentally changed how patients entered care, with:

• patients being triaged earlier and more effectively
• diagnostics were brought forward in the pathway  
• referrals were routed to the most appropriate provider across the system.

The impact was significant and included:

• people waiting 52+ weeks down by more than a factor of ten in two years, from 1,900 in June 2021 to 130 in May 2023
• patients overdue follow-up reduce by a third, 50,000 to 14,000 over the same period – with ongoing reductions
• rapid triage (typically within half a day) ensuring urgent or high-risk patients can be referred urgently.
• ophthalmology shifted from being one of the highest-risk specialties to a managed and controlled pathway.
    
  This model is now being expanded into ear, nose and throat (ENT) and neurological and musculoskeletal pathways (NMSK), aligning with the national ‘advice and referral’ direction and reducing unnecessary outpatient demand.
   
  What makes this approach particularly valuable is not just the outcome, but the way it was enabled through the clinical network leading change at the point of entry, executive governance groups aligning finance, operations and clinical leadership and regular cross-system forums building trust and enabling rapid problem-solving.

Key takeaway

For less mature systems, this provides a clear lesson - the greatest gains are often found not by adding capacity, but by redesigning how patients flow through the system together.