We directly supported waves one and two of the development collaborative, supporting leaders and frontline teams in seven local areas. In wave one, Stockport, Frimley, Fylde Coast, and South Somerset tested ideas across three specialties: diabetes, musculoskeletal and gastroenterology. In wave two, teams from Dorset, Lincolnshire, Norfolk and Stockport focused on ideas relating to dermatology, diabetes and ophthalmology. Handbooks for both of these waves have now been published on the NHS England website.

The framework for experimentation for the 100 day challenges included:

• Rethinking referral models to break down barriers between different care settings and ensuring that people could access care in the right place, first time
• Maximising the role of shared decision making and self management support in the elective care pathway
• Transforming outpatient appointments to better meet patient needs

Through implementing ideas such as MDT community masterclasses, patient held care plans and records, and enhancing advice and guidance between care settings, the teams were able to achieve results such as:

• Improving the quality referrals and reducing the volume of unnecessary and avoidable referrals; whilst
• Ensuring those that needed it, got rapid access to support, advice and guidance from clinical teams; and
• Enabling people to be better informed about managing their condition and journey through the elective care system so that they get the right care, in the right place, at the right time.

Waves three to five of the collaborative are being led by the NHS England specialty based transformation team who are also leading on disseminating the learning from the efforts. The final wave (five) is due to complete in Spring 2019.