The Guardian

Plan to ease backlog in hospitals will overload GPs, doctors warn

- Denis Campbell Health policy editor

Plans to scrap tens of millions of “unnecessar­y” hospital follow-up appointmen­ts could put patients at risk and add to the overload at GP surgeries, doctors have warned.

Health bosses in England are finalising a plan under which hospital consultant­s will undertake far fewer outpatient appointmen­ts and instead perform more surgery, to help cut the NHS backlog and long waits for care that many patients experience.

The move is contained in the “elective recovery plan” which Sajid Javid, the health secretary, will unveil next week. It will contain what one NHS boss called “transforma­tive ideas” to tackle the backlog. Thanks to Covid, the waiting list has spiralled to a record 5.8 million people, and Javid has warned that it could hit as many as 13 million.

Under the plan, patients who have spent time in hospital would be offered only one follow-up consultati­on in the year after their treatment rather than the two or more that many get now.

“While it is important that immediate action is taken to tackle the largest ever backlog of care, these short-term proposals by the health secretary have the potential to present significan­t challenges for patients and seek to worsen health

disparitie­s across the country,” said Dr David Wrigley, the deputy chair of the British Medical Associatio­n.

The plan has been drawn up by Sir Jim Mackey, the chief executive of Northumbri­a hospital trust, who is widely admired in the NHS for finding creative solutions to problems in the service. Last month he set out how hospitals could relieve the huge pressure they are under by slashing “on an industrial scale” the number of “pointless reviews” consultant­s carry out, switching instead to a new model under which patients would tell the hospital if they felt they needed a check-up.

One idea under discussion is that patients will be told to use an app to let their hospital know that they are sufficient­ly worried about their health that they want to see a doctor sooner than their next scheduled appointmen­t.

Outlining the thinking behind the plan, Mackey acknowledg­ed that some patients, especially those who may not use a mobile phone or a computer, including poorer and older people, could miss out on care as a result.

Hospitals in England undertook 124.9m outpatient appointmen­ts in 2019-20. Mackey said that “twothirds of outpatient­s volume is review, and we have all personally experience­d pointless reviews of very low clinical value and low patient experience value”.

But Wrigley cautioned that “relying on a patient-initiated follow-up model, while of benefit to some wishing for more booking autonomy, risks alienating those who may not have the capacity or access to an app or simply do not seek a follow-up appointmen­t when they need one.”

Chris Hopson, the chief executive of NHS Providers, welcomed the plan but added that the less regular in-person assessment of patients would involve “clinical risk”.

Hopson said: “For some procedures, for example, follow-up appointmen­ts are scheduled for three, six, nine and 12 months after an operation. But if all is well with the patient, it’s only the six-month review that is clinically vital.

“One idea being examined is whether the NHS could say to patients, ‘we will definitely schedule the six-month follow-up, but give you the ability to trigger a three, nine or 12-month review if you feel that’s necessary’. If this approach could be applied consistent­ly it would free up a lot of consultant time to do more surgery, thereby cutting waiting lists significan­tly faster.”

The BMA, the Royal College of GPs and the NHS Confederat­ion all warned that patients without a hospital follow-up could seek help at already hard-pressed GP surgeries.

Ruth Rankine, the director of primary care at the NHS Confederat­ion, said effective communicat­ion would be needed to educate the public about the change.

“If we fail to get this right, then the consequenc­es for general practice are huge, with potentiall­y significan­t additional demands on their time when they already are under unsustaina­ble levels of pressure,” she added.

 ?? ?? ▲ Sajid Javid is to unveil an ‘elective recovery plan’ for the NHS next week
▲ Sajid Javid is to unveil an ‘elective recovery plan’ for the NHS next week

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