GIRFT’s operational guide demonstrating how standardising clinic templates could potentially unlock up to two million outpatient slots per year nationally has now been updated.
The guidance outlines successful approaches, challenges and enablers (including digital enablers) and detailed examples from trusts who have reviewed their outpatient templates and used the additional capacity to prioritise new patient appointments.
Data shows that 80% of patients on the referral to treatment (RTT) elective waiting list are waiting to be seen in outpatients, with the NHS delivering around 2.2 million outpatient appointments each week. The current outpatient waiting list in England stands at around six million.
NHS England’s 2025/26 national priorities and operational planning guidance focuses on improving the percentage of patients waiting 18 weeks for treatment to 65% and the percentage waiting 18 weeks for a first appointment to 72% (with every trust expected to deliver a minimum 5% point improvement), and reducing the proportion of people waiting over 52 weeks for treatment to less than 1% by March 2026.
To help achieve this, GIRFT is working with NHSE’s Elective Care Improvement Support Team on an outpatient focused support offer, helping trusts to diagnose, reset and restart delivery of outpatient care and help reduce waiting times.
In May 2025, Professor Tim Briggs – GIRFT programme lead and NHS England’s National Director of Clinical Improvement and Elective Recovery – set all trusts the challenge of standardising clinic templates across the 17 Further Faster specialties.
Early findings from 28 trusts have fed into the new GIRFT operational guide, showing clear evidence that reviewing templates can unlock substantial outpatient capacity. The additional activity identified so far equates to around 300,000 appointments, achieved through reviewing session lengths, slot timing and new-to-follow-up ratios, combined with improved governance and integration with job planning.
If all trusts do the same there is an opportunity for between one and two million additional outpatient slots per year – the equivalent of an additional week of outpatient activity in every trust in England.
The guidance offers actionable steps to support this improvement and can be used by outpatient teams – clinicians, nurses, AHPs, administrative and management – as a framework for delivering sustainable impact across all relevant specialties.
It is the first in a new GIRFT series of resources supporting staff involved in running and improving outpatient departments to optimise services and understand how each part of the pathway contributes to the overall goal; that of improving patient and staff experience.
Other guides will follow on topics such as pre-referral optimisation, outpatient booking and scheduling and appointment delivery.
Professor Briggs said:
“Reducing unwarranted variation in clinic templates is a critical lever in restoring timely access to care. The actions described in this new GIRFT guidance are urgent, necessary and achievable and will accelerate outpatient reform.
As clinicians, if we all saw one or two extra new patient appointments in each of our clinics there would be a significant reduction in waiting times for our patients, resulting in more timely care.”
