One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey

Abstract

Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

Figure 1

Three illustrative figures reflecting how effectively a department delivers care in relation to the 18 ww pathway. The first graph: (a) depicts an ideal negative “ski slope” shape curve, where the majority of referrals are seen and treated at the beginning of the pathway, implying that a department has adequate resource to cope with demand. This is opposed to a wider distribution in (b) or bimodal pattern in (c), with peaks at either side of the 18 ww threshold (or target) implying an unsuccessful attempt to rush through patients at the end of the pathway in order to meet target compliance (avoiding fines imposed by the NHS) rather than improve patient care, as is intended by the 18 ww. (a) Ideal “ski slope” curve. (b) Wider distribution, and (c) bimodal pattern implying a struggle to meet the demand of referrals.

Figure 2

Layout and patient flow and though see the one-stop clinic.

Figure 3

18-week wait compliance before and after institution of the one-stop clinic for minor skin cancer surgery, compliant months (>95%) in orange.

Figure 4

Four-month comparison of 18 ww performance, as a percentage distribution pattern of the week patients received treatment after initial referral. The 18 ww threshold is marked as a vertical black dotted line. The comparison commences one month prior to the OSCs institution in August. This figure relates to Figure 1, which provides exemplars to translate changing distributions.

Figure 5

One-year review of 18 ww performance, showing the number of patients added to the departments' waiting list each week, the median trend represented by the orange dotted line, and weekly fluctuation in purple. The lower the number, the better the performance as patients are being treated in the OSC such that they are not added to the normal waiting list (i.e., standard non-OSC care pathway).

Figure 6

A survey of UK plastic surgery departments' utilisation of one-stop minor surgery skin cancer clinics.