• Patients to be seen virtually in different regions under national outpatient push
  • Trusts in areas struggling with long waiters to partner with high performing trusts in other regions
  • Mackey: outpatient project cornerstone of next phase of elective recovery plan

Patients at trusts with long waiting lists should no longer think “they have to go to their local hospital” for outpatient appointments, but should instead be offered virtual consultations elsewhere in the country where there is greater capacity, Sir Jim Mackey has told HSJ.

The NHS England elective chief said recent efforts to abolish two-year waiters by July had meant a “very big” surgical focus. However, the next phase of the elective recovery plan would see a major shift of emphasis onto reducing the wait for outpatient appointments.

The NHS’s next target is to eliminate 78-week plus waiters by March. There were around 57,000 78-week waiters according to the latest official data from May.

NHSE leaders are very concerned about a cohort of “over a million patients” who could tip into the 78-week breach category if they are not treated by March and there is widespread concern the target will not be met, as HSJ revealed last month.

Ending two-year waits

The NHSE elective recovery plan, published in February pledged that “by July 2022, no one will wait longer than two years”. There was, however, a caveat which said “a very small number of specific highly specialised areas may need tailored plans to tackle the backlog, as was the case before the pandemic”.

HSJ understands system leaders quickly resigned themselves to the fact getting to zero would not be possible because of the combination of patient choice and complex cases, as exclusively revealed by HSJ in May.

And it subsequently emerged, although this was not made public, that “a very small number” was defined internally by ministers and system leaders as under around 3,000.

This interpretation of what is meant by “a very small number” remains contentious. The figure is nearly double the number of one-year waiters pre-covid, and one well-regarded NHS policy expert told HSJ it was “a ruse”.

But NHSE and ministers have today declared the service has met its first elective recovery plan milestone of eliminating two-year waiters. It announced the number of 104-week waiters at the end of last month had been reduced to 2,777 and that the target had “virtually” been achieved.

The NHSE data showed that, of these 104-week plus waiters still on the list, 1,579 remained there because of patient choice; 1,030 because they were deemed clinically complex as defined below, and 160 because of “capacity problems”.

Sir Jim thanked NHS staff for their “hard work” in helping bring down the number of two-year waiters. Health and social care secretary Steve Barclay praised NHS leaders for having “successfully delivered on the first major target in our elective recovery plan”. Mr Barclay added: “This is testament to NHS staff who have worked incredibly hard to get us here – despite the significant challenges.” 

Virtual outpatient model could help struggling regions

The NHSE data underlines the huge regional variation in performance, with the South West, the Midlands and North West all struggling far more than other parts of the country – a trend highlighted previously by HSJ   (See table 1). 

Sir Jim said: “Providers have been split into tiers again with tier one having national oversight and tier two, regional oversight. Behind that we will be pairing up organisations so that organisations with capacity can help those with the biggest challenges from a virtual outpatient perspective.”

He added: “There still is a lot to work through [on virtual outpatients], we’re going to be testing the concept… We need to work through how all the wiring and plumbing needs to work. For example, what happens if the patient needs a diagnostic locally, having seen a clinician virtually in another part of the country?

“It would be great also to try and stimulate more of a consumer drive on this – encouraging patients to ask about virtual outpatients when the waits locally may be too long, so they don’t just think they have to go to their local hospital. I think this could really help shift the model if we can get it right.”

He also refreshed his calls for trusts for patient initiated follow ups to be rolled out on an industrial scale.

Sir Jim said: “I do believe strongly that we really need to have a go at inverting the outpatient model, and for trusts to have a go at doing their version of what Norfolk and Norwich are doing [NNUH is overseeing the NHS’s most ambitious patient initiated follow up programme].”

Table 1: Breakdown of 104-week waiters left by region and by choice, complexity or capacity

  

Region

Total

Choice

Complex

Capacity

East of England

138

100

34

4

London

82

50

32

0

Midlands

768

277

491

0

North East and Yorkshire

158

60

96

2

North West

463

377

86

0

South East

60

37

21

2

South West

1,108

678

270

160

England Totals

2,777

1,579

1,030

168

Source: NHS England

 

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