Why are we still making patients wait months for appointments that could happen closer to home, or without a hospital visit at all? It's time to rethink a system built around hospitals rather than patients.
Back in 2007, as a fresh eyed medical student, I sat in outpatient clinics and wondered why we practised this way.
Patients waited months for a short consultation, then left with a list of investigations. Why couldn’t those tests have been done beforehand? I assumed I’d understand once I qualified.
Almost 20 years on, my paediatric respiratory clinics look much the same, wherever I work in Australia. Senior colleagues who have been around for decades agree that very little has changed. Apparently, this is tradition.
Covid briefly interrupted proceedings. Suddenly, we were doing video consultations from home. Insistence on examining every chest and abdomen largely fell away. We still examined patients when needed but discovered how much care could happen remotely. Why haven’t we kept that flexibility?
If we were designing a hospital from scratch today, would we recreate outpatients? Probably, knowing how slowly we change in healthcare. But should we? Surely we can do better than a model that asks patients to organise their lives around our waiting rooms.
Here are five examples of how we could rethink outpatient care, from the first referral to long term follow up. They are just scratching the surface.
Sam cannot wait another birthday
Sam is two and lives in regional Victoria. He snores loudly, sleeps restlessly and has pauses in his breathing. His speech and language are behind. His parents have waited eight months for a sleep assessment at a tertiary children’s hospital.
Every night his parents check his breathing and anxiously record episodes. Appointment day means driving to Melbourne, time off work and expensive parking.
When I see children like Sam, I take the history, watch the recording and examine them. Too often, I arrange investigations that could have started months earlier. The family faces another wait.
Disrupted sleep and breathing can affect a child’s learning and development. Yet answers can take years. Hospital sleep studies need overnight beds, specialised equipment and trained staff, and places are limited.
In some services, waits for lower priority sleep studies can easily stretch beyond two years. Two years is a long time when you are two.
Imagine starting that work before the hospital appointment.
Sam’s GP examines him, checks for anything urgent and starts initial management. Through Advice & Guidance, the GP shares the history, examination findings and parents’ recordings with a respiratory and sleep specialist at the tertiary children’s hospital.
Here, the specialist responds within 24 hours, advising on investigations and whether Sam needs earlier assessment. His GP starts investigations while the hospital arranges a video consultation.
Sam and his parents join from home or their GP’s practice. I clarify his symptoms, discuss his development and explain the plan. His parents ask the questions that are keeping them awake. Nobody has had to find a parking space.
Home overnight oximetry, performed locally, is reviewed by the sleep team and guides further testing, including a supervised sleep study if needed. Hearing and speech assessments also happen close to home.
His GP and specialist can review results together in a case conference. If Sam needs to attend hospital, that visit has a clear purpose and expectations.
Every specialty has its Sam. Many patients can be managed safely closer to home, with specialist advice, virtual reviews and assessment in person when needed. Hospital expertise should follow the patient.1,2
Related
Every follow up needs a purpose
That same question of purpose applies after discharge. A junior doctor books a review in ‘four to six weeks’. That might mean six weeks or somewhere in the next 52. Too often, nobody asks what the appointment needs to achieve. It is booked because ‘that’s just what we do here’.
Follow up could start with the GP, supported by access to specialist Advice & Guidance. Some patients might benefit from a group outpatient session; others from a joint video consultation with their GP and specialist. Choose the interaction that helps.3
There is already a funding mechanism for eligible joint video consultations. The GP, sitting with the patient, can claim an MBS Patient End Support (PES) item, while the private specialist claims the relevant MBS video consultation item, subject to the requirements of both.9
The conversation also offers immediate learning and CPD for the GP, with specialist reasoning and practical advice discussed around their own patient.
Why couldn’t this virtual model of care and MBS funding be extended to public specialist consultations? Funding both the GP’s participation and the public specialist’s time would immediately create additional outpatient capacity.
Newly qualified specialists who have completed fellowship but are currently un- or underemployed could help deliver these virtual appointments, seeing patients alongside their GPs. This could put more of the specialist expertise already in our system to work.
Life after cancer with care close by
Better connections between GPs and specialists matter just as much for long term follow up. In cancer care, surveillance and survivorship support can keep people returning to hospital for years.
GPs may feel nervous taking over; oncologists worry about losing sight of patients. A reliable connection between them could change that.
Imagine Yasmin, 65, in remission after early breast cancer. Her oncology team agrees that GP care is appropriate. Her shared plan covers surveillance, mammograms, treatment effects and concerning symptoms, with clear responsibilities. Planned checks continue, and her GP can contact oncology services through a specialist Advice & Guidance channel.4
Yasmin is offered an ‘open appointment’ her GP can activate, rather than automatic hospital bookings at six or twelve months for years to come. Where appropriate, concerns prompt a video consultation with Yasmin, her GP, oncologist, breast cancer nurse consultant and social worker. Urgent concerns are triaged to a face-to-face review.
In this model, the team stays connected and time for collaboration is funded. Yasmin knows her trusted GP understands her treatment, and her oncologist remains accessible. The reassurance comes from knowing help is available when needed.
A safer journey home from hospital
That connection matters just as much in the days after leaving hospital. As a junior doctor, I faxed countless discharge scripts to community pharmacies, hoping the pharmacist would explain what I hadn’t. I’d also written ‘GP review in 48 hours’, as if that magically produced an appointment. What a mess.
Medication related problems account for an estimated 9% of admissions through ED, rising to one in five among older people.5, The Commonwealth already funds Home Medicines Reviews and Residential Medication Management Reviews, yet uptake is uneven and underutilised.6
Imagine arranging a virtual pharmacist review for a patient with multiple conditions and medicines, with their GP or discharging clinician joining when needed. MBS funding and pharmacist programs already exist; better pathways could help teams use them better.
A review organised around the patient’s immediate needs and risks would achieve far more than a fax, crossed fingers and a hospital appointment weeks later.
A specialist visit at the shops
While writing this piece, I read about Barnsley Hospital NHS Foundation Trust in England, which runs dermatology, eye care and rheumatology clinics in the Alhambra shopping centre.7
I thought of my mum, who sees her rheumatologist every six months for rheumatoid arthritis. My sister takes time off work to drive her to hospital. Mum doesn’t need special equipment or hospital tests for these visits. She needs her rheumatologist, and that is where the rheumatologist happens to be.
Mum goes to her local shopping centre all the time. Why couldn’t she see her specialist there too? We ask people to come to hospital because that is where the doctors are. But we can move.
Some equipment, tests and procedures will always need a hospital setting. Many consultations could happen closer to the places where people already spend their time.
Imagine a suburban shopping centre clinic with good public transport and cheaper, perhaps free, parking. See your specialist, collect your prescription, then shop for the healthy food you’ve discussed. The fitness centre on level 2 could help with that exercise prescription and the library next door with joining a community book club.
Time to rethink outpatients
We need shared care and value-based models that use existing funds, expertise, and technology more efficiently.8 That takes imagination about where and how care happens. “Come to the hospital and we’ll see you when we can” cannot be our best offer.
So, is outpatients outdated? The assumption that specialist care must revolve around a hospital appointment increasingly is. Sam needs investigations to start sooner. Yasmin needs reliable access to her team. My mum needs her specialist within easier reach. These examples barely scratch the surface, but they point towards a service organised around what patients need, when and where they need it.
Organising care this way will also free hospital appointments for people who need procedures, detailed examinations, hospital investigations or additional support. Some patients need or prefer care in person. They deserve timely appointments and enough time when they arrive.
Our outpatient system is overdue for its own specialist review. I’d rather not have to wait another 20 years for the appointment.
Associate Professor Vikram Palit is a paediatric respiratory physician and Associate Professor in Paediatrics and Child Health at Western Sydney University. He is the founder and CEO of Consultmed, which provides digital referral and Advice & Guidance services.
References
1. Royal College of Physicians and the Patients Association. Prescription for outpatients: reimagining planned specialist care. 16 April 2025.
2. ReState. Hospital of the future: hospital as a service, not a building. 22 May 2025.
3. Health Innovation East, with Elliott Engers. Outpatient care: a model for the future. 30 September 2025.
4. Cancer Australia. Shared follow up and survivorship care for early breast cancer: information for health professionals. 2020. Eligibility, shared care plans and rapid specialist access.
5. Lim R, Kalisch Ellett LM, Semple S, Roughead EE. The extent of medication related hospital admissions in Australia: a review from 1988 to 2021. Drug Safety. 2022;45:249 to 257.
6. Australian Commission on Safety and Quality in Health Care. Atlas Focus Report: Medication Management Reviews. Funding and variation in review uptake. Accessed 25 October 2026.
7. Barnsley Hospital NHS Foundation Trust. Alhambra Outpatients. Services and location. Reviewed 27 March 2026.
8. Fisher R, Beech J, Alderwick H, et al. The Health Foundation. Rethinking access to general practice: it’s not all about supply. March 2024.
9. Australian Government. Medicare Benefits Schedule. Explanatory note AN.0.79: Patient end support items. Updated 1 November 2026. https://www9.health.gov.au/mbs/fullDisplay.cfm?q=AN.0.79&type=note