How to eradicate the NHS waiting lists in just 100 days?

The number of patients on an NHS waiting list has swelled to more than 3.6 million (https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/). The situation is now so bad that NHS England has announced it is to relax the rules on waiting times (http://www.bbc.co.uk/news/health-36854557).

The problem is that hospital waiting lists are continually fed by the 90,000 patients a day that are referred by GPs across England and Wales. Jonathan Tomlinson, a blogging GP from East London, has written passionately about the dilemmas that GPs face when deciding whether or not to refer a patient. He cites three main reasons: (1) investigation and diagnosis; (2) treatment and (3) advice or reassurance for the patient and/or GP (https://abetternhs.wordpress.com/2011/11/04/referring/)

His last reason is key to the problem of growing waiting lists. GPs refer significant numbers of patients to hospital simply for advice or reassurance. But how many referrals does this cover? Amazingly, most studies have shown that 4 out of 10 referrals to hospital specialists could have been avoided and dealt with at source if the GP had had access to specialist advice (http://www.cinapsis.org/evidence-base). In many of these studies, the judgement of appropriateness is made by specialists but Ringberg (2015) recently showed that for 1 out of 4 referrals made by GPs, they themselves know that the patient will have no direct therapeutic benefit from attending the outpatient clinic.

The key to eliminating these “avoidable” referrals is by providing GPs with advice when they actually need it i.e. at the point they are considering referring a patient. In part the solution to this depends on web and telephone technology providing secure platforms through which clinicians can have safe, documented clinical conversations. However hospitals themselves need to recognise the significant benefits to be gained from making their specialist’s advice more accessible to GPs. By organising and incentivising their specialists to provide this advice to GPs and other clinicians in primary care, they would drastically cut down their own waiting lists and generate more income earning opportunities per capita on a waiting list.

The benefits of an improved network of communication between GPs and specialists to the health economy as a whole would be massive. Learning opportunities for GPs provided by these clinical conversations would generate significant long term benefits. Patients would be spared unnecessary trips to hospital and all the associated costs to the economy that these trips cost in lost opportunity.

But most importantly by avoiding 36,000 referrals a day we would eliminate the existing hospital waiting lists of 3.6 million in only 100 days. Even if we lowered our ambitions and reduced referrals by 20% a day by improving access to clinical conversations between GPs and specialists we would eliminate NHS waiting lists in less than a year. To deliver these benefits, all that is required is a change in thinking to the traditional outpatients model, to deliver a more collaborative model where GPs and specialists work together and not only improve patient care but deliver real efficiencies and savings.  

References.

Ringberg, U., Fleten, N., & Førde, O. H. (2014). Examining the variation in GPs’ referral practice: a cross-sectional study of GPs’ reasons for referral.Br J Gen Pract, 64(624), e426-e433.

Ringberg, U. (2015). General Practitioners’ Decisions to Refer Patients to Secondary Care–Referral Rates, Reasons for Referral and Expected Medical Benefit of the Referrals.

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