NHS England (NHSE) engaged clinicians on the transformation programmes in various ways including working with representative bodies and embedding National Clinical Directors within the programmes to provide medical leadership. The surgical transformation programme benefited from in-person engagement and support from the Royal College of Surgeons of England.50 On the diagnostics programme an independent review gave proposed changes credibility. However, clinical engagement on the outpatients programme, which involves a much wider range of clinical specialities, was significantly more challenging. The NAO report notes that local NHS systems accepted outpatients services could be improved but did not agree that reducing follow-up appointments was the right solution, and NHSE failed to get support from the Royal College of Physicians for the target to reduce follow-up appointments.51