The way hospitals in the UK manage outpatient appointments is blocked "in the eighteenth century," doctors say.
Every year millions of people go to hospitals, where doctors check their health and discuss their care.
The Royal College of Physicians stated that many appointments were not necessary – and outdated, inefficient systems meant that many numbers had been deleted or erased.
He said the situation was frustrating for patients and the waste of money.
The CPR report said the time has come to renew the system by embracing innovation: making more use of remote monitoring and telephone and video consultations.
It could also help other staff members, such as senior nurses, manage clinics closer to people's homes.
He said that a number of places had already started to take these steps, but there was still a lot to do.
The dott. Toby Hillman, of the PCR, said: "It is an eighteenth-century system: it should not be beyond us to tackle this problem".
What are the outpatient appointments?
Outpatient departments are the most active part of hospitals in terms of visa numbers.
There were 127 million UK appointments last year – almost five times more than the numbers that came to A & E.
Patients come in to discuss their health as part of their ongoing care, or they can see their doctor to discuss their recovery from surgery. or before they go under the knife.
The report stressed that these appointments may require a significant amount of time, costs and planning for patients due to things like travel, missing work and childcare organization.
But in England, one in five is canceled, or patients do not show up.
Some of the cancellations are unavoidable, due to illness or emergencies that require the use of personnel elsewhere.
But the PCR said that the majority could be avoided if better systems existed.
How the system breaks down
There are several reasons why the service does not work properly.
Surveyed doctors – there were about 1,400 respondents in the report – stated that some appointments had to be canceled because the test results were not yet available. or the scans were not booked on time.
A consultant described his experience as a "shocking" clinic, complaining about missing notes and results.
In cases where patients did not show up, the report said that there was evidence that they attempted to alert the hospital but there was no efficient way to record information.
The report states that hospitals have also struggled to cope with the demand: the number of appointments has doubled in the last ten years.
This combination of inefficiency and pure volume has contributed to a large number of appointments – 57% – late.
How many appointments are not necessary?
Doctors were asked if they believed that a significant minority of outpatient appointments – between 10% and 20% – could be avoided.
One in four said that this proportion of new appointments for patients was not simply necessary.
A similar number said that this percentage of follow-up appointments could be avoided by using alternative methods, such as video consultations.
If the number of missed and missed appointments has been reduced, this could also provide significant savings.
But the PCR has warned the financing system of hospital care needed to change.
Hospitals are paid per patient, so they could be penalized if they reformed the system.
The NHS England health director, prof. Stephen Powis, said doctors were as frustrated as patients about "old-fashioned" processes.
He said the problem will be addressed as part of the NHS long-term plan that is currently under development so that the outpatient service can be brought into the "21st century".
"The time has come to grab this nettle," he added.
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