Elective care reform needs more than targets — it needs teamwork
Elective care reform is about building systems that work for patients, clinicians, and communities, writes Bec Richmond, director at Optum
The NHS has set ambitious targets for elective care recovery. By March 2026, 65% of patients should wait less than 18 weeks for treatment, with every trust expected to deliver a minimum 5% improvement.
Advice and guidance incentives are scaling, aiming to divert 2 million patients from elective pathways in 2025/26.
The mandate’s clear, but targets alone won’t transform elective care. To address the challenge, we must rethink how outpatient care is delivered — and who delivers it.
Rethinking neighbourhoods: a new vision for outpatients
Whilst facilitating a recent workshop, an integrated care board (ICB) strategy lead asked: “What if neighbourhood health hubs became the epicentre of outpatient care?”.
The idea resonated. Everyone agreed that simply shifting more demand to already overstretched GPs wasn’t viable.
With funding flowing to models like the Neighbourhood Health Hubs outlined in the 10 year health plan — and already functioning in some areas — local hubs could house diverse, multidisciplinary teams delivering multi-faceted care and support.
These teams wouldn’t just be clinical; they’d include community pharmacy, helping patients access care faster, stay well, and return to work.
This approach would ease pressure on GPs and bring much-needed revenue to local pharmacy teams. Acute and specialist input would still be available virtually.
The result? A more accessible, integrated, and patient-friendly outpatient experience.
But this isn’t just a future vision. It’s already happening.
Even without full hub infrastructure, neighbourhood working is enabling primary care at scale — built on integrated systems, powered by population health-informed analytics, and delivered by teams shaped around local needs.
We’ve seen it in models like North West London ICB’s Octopus model and Ontario’s Health Teams in Canada.
Collaborative working, patient and family engagement, proactive outreach, and co-location of teams are central — and digital transformation is key to scaling up these approaches.
Digital tools as enablers of teamwork
To realise this vision, we need a digital-first approach that supports efficient, flexible outpatient care.
Digital tools are already unlocking clinical capacity and enabling diverse teams to deliver care that’s responsive to local needs.
Standardised pathways embedded into clinical workflows help teams quickly action the next step — which might be referral into a local non-clinical service, avoiding unnecessary waitlists.
Decision support and access to specialist advice enable primary care professionals and their extended team colleagues to provide whole-person support quickly and confidently.
Faster access to diagnostics and results supports collaborative decision-making and enables Patient Initiated Follow Up), putting informed choices back in patients’ hands. And we have the tools to make this happen.
We’re developing an integrated care platform to support this shift — embedding capabilities that help frontline teams coordinate care, surface population-level insights, and manage elective pathways more proactively.
These capabilities help expand the workforce able to manage the elective care backlog and shift care out of hospitals — making care more personalised, timely, and aligned with people’s lives.
By embedding digitally-enabled approaches into neighbourhood models, we can improve access, continuity, and the overall patient experience — often before a patient even needs to cross the threshold of a future Neighbourhood Health Hub.
Supporting patients beyond the waitlist
One of the most overlooked aspects of elective care reform is what happens to patients while they wait — or when they no longer need to.
Giving visibility to waiting lists is a first step – and one we can deliver now. But it’s the ability to act on that data that transforms care.
When GPs and neighbourhood teams can see waitlists on their desktops, they can take meaningful action – removing patients from pathways they no longer need, rationalising referrals, offering alternatives, and prioritising based on risk, need, and personal preference.
This digital capability ensures that “left shift” doesn’t just mean shifting the burden — it means solving the problem. It helps patients wait well, or avoid the wait altogether. It’s about whole-person support, not just clinical triage.
A partner that supports system change
Elective care recovery is one of the NHS’s biggest challenges — and one of its biggest opportunities. An opportunity to do things differently.
To commission strategically. To embrace the three shifts outlined in the NHS 10 year health plan — upstream, out of hospitals, and into neighbourhoods — and deliver real impact.
We see an opportunity to work with community pharmacy, local authority and social care teams, and those with lived experience alongside core NHS teams to make this happen. It’s what we’re working on and what we’d like to talk to more organisations about making happen — now and as we build towards the 10 year health plan vision.
Because true transformation requires stronger collaboration — not just between care teams, but with patients and families.
It also means integrating suppliers as partners — not pitching products, but co-creating solutions in a robust ecosystem of end-to-end care and support.
At Optum, we believe technology partners have a responsibility to support system change — not just through tools, but through insight, collaboration, and shared purpose.
Elective care reform isn’t just about hitting targets. It’s about building systems that work — for patients, for families, for clinicians, and for communities. So let’s get to it.
