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