Case Study - Transforming Elective Recovery - A System-Wide Community ENT Model in South East London

South East London (SEL) has delivered a large-scale transformation of ENT services, reducing waiting lists by 33% and cutting long waits by over 2,000 patients while shifting 82% of care into community settings.

Through a clinically led, system-wide model built on a Single Point of Referral, one-stop pathways, and integrated working across primary, community and secondary care, SEL has released over 17,000 acute outpatient appointments annually and significantly improved access, equity, and patient experience.c

This sustainable, financially efficient model is now embedded as core infrastructure
and provides a replicable blueprint for elective recovery across the NHS,

The Challenge

ENT services across South East London were under sustained pressure, intensified by the COVID‑19 pandemic. Demand was rising sharply while capacity remained constrained:

• Waiting list increased from 14,000 pre-pandemic to over 26,500 by June 2024
• > 600 patients waiting over 65 weeks, among the highest nationally
• Average waits for non-admitted patients exceeded 22 weeks
• Workforce limitations and concentration of services in acute settings restricted access

Access was also inequitable. In Bromley, representing 18% of the population, local ENT provision was limited, requiring patients to travel and increasing pressure on acute hospitals.

The system needed to simultaneously:

• Reduce backlog at pace
• Manage increasing demand
• Improve equity of access
• Build sustainable capacity for the future

The Approach
An innovative joint provider model was established to manage backlog recovery alongside new demand, ensuring sustainability of outcomes.

Single Point of Referral (SPR)
A single, standardised entry route for GPs:

• Streamlined referral processes
• Reduced duplication
• Enabled consistent triage and prioritisation

One-Stop, High-Value Care
Patients increasingly receive assessment, diagnostics, and treatment in a single visit:

• Reduced follow-ups
• Faster clinical decision-making
• Improved experience

Integrated System working
A fully joined-up pathway across:

• Primary care (enhanced Advice & Guidance)
• Community providers (expanded clinic capacity)
• Acute trusts (focused on complex care)
• Audiology and diagnostics

Clinical pathways, governance, and delivery were co-designed and jointly owned across providers, supported by strong clinical leadership and system oversight.

Delivering change at pace
Despite the urgency, the programme prioritised inclusive, system-wide
collaboration:

• Joint clinical leadership from ENT consultants and GPs
• Co-designed service specification involving clinicians, operational teams, and patient representatives
• Regular system mobilisation forums enabling rapid decision-making
• Real-time pathway refinement to reflect new guidance

Community clinicians were enabled with:

• Access to the London Care Record
• Digital Advice & Guidance (Consultant Connect)
• Secondary triage supporting ​“straight-to-test” pathways

This allowed rapid implementation while maintaining safety, consistency, and clinical confidence.

Impact and Outcomes
The model has delivered significant, measurable improvements:

• 33% reduction in waiting list size
• >2,000 reduction in 52-week waits
• 65-week waits reduced by 97%
• Median wait reduced from 22 weeks to 4.5 weeks
• 18-week performance improved by 13%

System efficiency impact:

• 82% of activity delivered in community settings
• 17,300 acute outpatient appointments released annually
• 1,000+ patients managed in primary care without hospital referral

Access and Equity impact:

• New community clinics in underserved areas
• 3,000+ Bromley patients treated locally in one year

Financial Impact

• Activity delivered at 85% of acute tariff
• Estimated £355k annual saving compared to acute delivery

Patient and Staff Experience
Patient feedback highlights the impact on access and quality:

“The entire process was extremely smooth, efficient and friendly… Appointment times were almost immediate.”

“Efficient, effective & local. Much better than waiting for a hospital appointment.”

Staff report improved ways of working:

• Reduced duplication
• Improved workflow
• Greater focus on complex cases

What makes the model different?
This was not simply backlog clearance – it was system redesign:

• Demand management through Advice & Guidance
• Flow control via SPR
• Non-complex care shifted to community settings closer to home
• Release of acute capacity to focus on complex, surgical and cancer care

The model balances short-term recovery with long-term sustainability.

Scaling and Transferability
The model was designed for replication:

• Standardised pathways and governance
• Flexible community delivery model
• Strong clinical leadership embedded

It is already influencing wider adoption, with some London ICBs aligning service specficiation inclusion criteria and engagement from wider ICBs to inform their recovery approaches.

The approach is transferable to other high-volume elective pathways suited to out of hospital care, such as Dermatology and Gynaecology.

Sustainability and Future Direction
The model is now embedded as core system infrastructure, supported by:

• Recurrent system funding
• Integrated governance and performance oversight
• Continuous improvement processes

It contributes directly to long-term NHS resilience by:

• Reducing reliance on acute care
• Protecting capacity for urgent and complex patients
• Strengthening primary and community care

Find out more
For a more detailed discussion, contact the Service Development Team:
Anna Bernard, Senior Service Development Manager: anna.bernard@nhs.net

Kieran McHugh, Head of Service Development: Kieran.mchugh6@nhs.net