Health secretary Alan Milburn has told trusts they must implement a new programme to improve the management of outpatient services and cut waiting times.

Mr Milburn said latest figures showed a 'dramatic slowing' in the rate of increase in the number of people waiting for outpatient appointments and this indicated the NHS was turning the corner on outpatient lists.

But he made it clear that trusts would have to deliver reductions by reducing the number of wasted appointments and tailoring clinics to suit patients.

However, managers warned that Mr Milburn's plan could backfire by stoking demand and increasing pressure on inpatient services.

Between June and September, the number of patients in England waiting longer than 26 weeks for a first outpatient appointment rose 3,000, or 2.3 per cent, to 149,000. In the same period last year, there was a rise of 18,000 or 16 per cent, to 126,000.

Fifty-eight thousand more patients were seen between June and September this year than last year.

Mr Milburn gave trusts 12 months to overhaul their outpatient systems, through the implementation of five key measures, recommended by the Department of Health and the National Patients' Access Team:

New booking systems so that patients can choose, four weeks before their appointment, a date and time which is convenient for them. The project team found this system cut waiting times by up to 40 per cent by reducing did-not-attends and cancellations.

Action to reduce waiting times in clinics with particular problems.

All health authorities, primary care groups and trusts to agree long-term plans for outpatient improvements.

Each trust to identify an executive director with responsibility for outpatients, plus a dedicated outpatient manager.

By end of March 2000 every trust to have produced an outpatient improvement plan.

The DoH's new 'waiting list buster', chief executive of Basildon and Thurrock trust Sue Jennings, was confident that self-booking by patients would have 'a significant impact' on waiting times.

But the NHS Confederation's policy director, Nigel Edwards, said: 'Without a strategy to manage demand, reductions in waiting times can lead to an increase in referrals, meaning there is little long-term benefit.'

Waiting Times for First Outpatient Appointments in England: quarter ended September 1999.

Variations in Outpatient Performance.