Outpatient Transformation
Progress against NHS England's Outpatient Recovery and Transformation Programme across the Shelford Group
NHS England's Outpatient Recovery and Transformation Programme is built around three strands: personalised follow-up (e.g. Patient Initiated Follow-Up), referral optimisation (e.g. Specialist Advice & Guidance), and specialty redesign. This page tracks the first two, which have robust national data collections; the third — specialty-level progress — is being sourced directly from Shelford trusts and will be added once available (see note at the foot of the Referral Optimisation section).
1) Sheffield PIFU (monthly) data stops at August 2025 in the source file — held over with a note throughout, and excluded from the Shelford PIFU monthly trend line to avoid distorting the time series (consistent with how Sheffield is handled on the RTT page). This does not affect the FY2024/25 PIFU utilisation rate below, where a full 12 months of Sheffield data is available.
2) Specialist A&G "Processed" and "Diverted" figures lag behind "Total Requests." England's processed-to-total ratio holds steady at 87.6–89.0% every month from January to June 2026, then falls to 84.9% in July and 72.0% in August 2026, a clear sign that recent outcomes are still being reported rather than a real change in practice. Total Requests, Pre-referral and Post-referral splits are recorded at request time and show no such drop, so those use August 2026; Processed, Diverted and Diversion Rate use June 2026, the latest month before this lag effect appears. NHS England's file is refreshed in full each month, so earlier months can change as trusts resubmit. The largest revision in this release is Oxford, whose June and July 2026 totals have roughly doubled (to 8,515 and 8,902), so the whole series on this page is taken from the latest file.
3) PIFU Utilisation Rate and DNA Rate are FY2024/25 figures from NHS Hospital Episode Statistics (Outpatient, Provider-Level Analysis) — 2025/26 data isn't published until September. These are annual, not monthly, and sit alongside (not blended with) the live monthly PIFU episode counts elsewhere on this page. PIFU Utilisation Rate = FY24/25 PIFU episodes ÷ FY24/25 attended outpatient attendances. DNA Rate = DNA ÷ (Attended + DNA). Three trusts (Birmingham, GSTT, Manchester) appear in the HES file under suffixed codes (RRK-X, RJ1-X, R0A-X respectively) rather than their standard ODS codes — mapped and verified before extraction.
4) England benchmark lines on the trend charts use the national per-provider average scaled to Shelford's trust count (×9 for PIFU ex-Sheffield, ×10 for Specialist A&G), not the raw England total, since Shelford is a small subset of the ~134–140 providers in each file and a direct total-to-total comparison would not be meaningful.
Referral Optimisation (Specialist Advice & Guidance)
Specialists respond to GP requests for advice before or after a referral is made, diverting patients who don't need an outpatient appointment away from the referral pathway entirely.
Source: Provider Specialist Advice Activity full dataset from April 2022 (NHS England, data extract to August 2026, published 8 October 2026). Total/Pre/Post: August 2026. Processed/Diverted/Diversion Rate: June 2026 (see reporting-lag note above).
Trust-Level Specialist Advice & Guidance Activity
| Trust | A&G Total | Pre-referral | Post-referral | Processed† | Diverted† | Diversion Rate† |
|---|
† Processed/Diverted/Diversion Rate figures are June 2026 (see reporting-lag note above).
Specialist A&G Total Requests Trend – Shelford vs England Benchmark
Source: Provider Specialist Advice Activity full dataset, Apr 2022 – Aug 2026. Shelford = sum of all 10 trusts. England benchmark = national average per provider × 10.
A&G Diversion Rate Trend – Shelford (Weighted) vs England
Source: Provider Specialist Advice Activity full dataset, Apr 2022 – Jun 2026 (Jul and Aug 2026 excluded — see reporting-lag note above). Diversion rate = diverted ÷ processed requests.
Pre- vs Post-Referral A&G by Trust – August 2026
Source: Provider Specialist Advice Activity full dataset, August 2026. Pre-referral (Advice & Guidance) occurs before a referral is made; post-referral occurs afterwards. The split varies significantly by trust, reflecting different service models.
Specialty-Level Referral Optimisation 5 of 10 trusts reporting
Neither NHS England source file on this page carries a specialty breakdown, so this data is sourced directly from Shelford trusts via a shared benchmarking template. Five trusts have submitted so far: Cambridge (April–September 2026, 6 months), King's (April–August 2026, 5 months), GSTT and Imperial (April–July 2026, 4 months), and Newcastle (April–June 2026, 3 months). The remaining five trusts have not yet submitted. Columns use the agreed standard specialty set, and trusts are not expected to report every specialty. Cambridge's own submission labels two of these "Clinical Haematology" and "Respiratory Medicine" — mapped here to Haematology and Respiratory respectively.
| Trust | Gastroenterology | Cardiology | Neurology | Gynaecology | Urology | Rheumatology | Dermatology | ENT | Respiratory | Haematology |
|---|
"Monthly Avg A&G Requests" divides each reporting trust's period total by its number of reporting months, since trusts have submitted different-length windows so far — this keeps trusts comparable despite that. % Advice-only and % Converted to OP are rates and unaffected by window length. "—" indicates no data for that specialty: a nil return, a specialty not included in that trust's submission, or a trust that has not yet submitted. ‡ King's Gastroenterology is excluded for now: King's currently records Gastroenterology and Liver services together, and the outcome counts include Liver activity on a different basis from the request count, so the rates cannot be calculated reliably. King's separated the two services last month, so this should resolve in a future submission.
Trust-Level Detail — Full Monthly Breakdown
Month-by-month figures for each specialty, for the five trusts that have submitted so far.
"—" indicates no data for that specialty in that trust's reporting window (a nil return, or a specialty not included in the submission). ‡ Excluded — see note under the table above.
Personalised Follow-Up (PIFU)
Patients initiate their own follow-up appointment when needed, rather than being brought back on a fixed schedule. NHS England's target is for PIFU to reach at least 5% of all outpatient appointments by March 2029.
Sources: PIFU Activity by Month and Provider (latest available month per trust, to May 2026; Sheffield Aug 2025) and Hospital Episode Statistics Outpatient Provider-Level Analysis FY2024/25 (utilisation rate & DNA rate).
Trust-Level PIFU Activity
PIFU Episodes: latest available month (May 2026; Sheffield Aug 2025†). Attendances, DNA Rate, PIFU Utilisation Rate: FY2024/25.
| Trust | PIFU Episodes | Attendances (FY24/25) | DNA Rate (FY24/25) | PIFU Utilisation Rate (FY24/25) |
|---|
† Sheffield PIFU episode figure is Aug 2025 (last available month); its FY2024/25 utilisation rate and DNA rate are unaffected and based on a complete year.
PIFU Episodes Trend – Shelford (ex-Sheffield) vs England Benchmark
Source: PIFU Activity by Month and Provider, Aug 2021 – May 2026. Shelford = sum of 9 trusts (Sheffield excluded from trend due to data gap since Aug 2025). England benchmark = national average per provider × 9.
PIFU Utilisation Rate by Trust – FY2024/25
Source: PIFU episodes (Apr 2024 – Mar 2025 sum) ÷ attended outpatient attendances, HES Outpatient Provider-Level Analysis FY2024/25. Dashed line: NHS England's 5%-by-March-2029 target.
Outpatient DNA Rate by Trust – FY2024/25
Source: HES Outpatient Provider-Level Analysis FY2024/25. DNA Rate = Did Not Attend ÷ (Attended + DNA).