Our conversations with leaders from large scale primary care organisations and trusts on their work to reduce waiting times and support those patients who are waiting, highlighted the following enablers.
Local Enablers
- Building strong relationships and mutual understanding is key. The health and care system has faced unprecedented demands over the course of the pandemic. New focus is needed to develop a shared understanding of issues and to co-create new pathways which remove barriers for patients, trusts and GPs alike.
- There will not be a 'one size fits all' model across the country on where conversations between primary and secondary care should take place. Colleagues from primary care and secondary care will need to work with the most appropriate 'unit' for their local footprint. In some instances, this will be clinical commissioning groups or PCNs, in others, a GP federation or a large-scale practice.
- Primary and secondary care providers will need to collaborate in assessing and managing the care backlog. This is likely to include introducing local processes to check data and details on waiting lists, ensuring shared input into clinical prioritisation, and establishing protocols for patient communication which ensures individuals are kept up to date about their planned care pathway and any delay to any step of it.
- Diagnostic pathway changes are central to improving patients' experience of care. Given the likelihood of longer waiting times for treatment, better communication between trusts and GPs can reduce the uncertainty at the outset of care as patients wait for tests or receive a diagnosis. These case studies display diverse approaches but have in common ensuring patients, GPs and consultant staff have shared visibility of results and treatment options.
- Data on new pathways must include ethnicity and deprivation so that the impact on exclusion can be fully understood. Colleagues across primary care and secondary care should work together to baseline data at both ends of any new pathway.
- NHS leaders now wish to assess which innovations should be retained as 'business as usual' and highlighted the following considerations:
- Digitally enabled services should be considered as a priority where connectivity can reduce the need for travel or allow information to be collated before clinical advice is requested. New funding models for these services are also vital to sustain innovation beyond the pandemic.
- A greater volume of outpatient practice can be undertaken within primary care led services, including using digital approaches. The examples in this briefing help to meet demand through co-located multi-disciplinary working in accessible locations, and often have higher discharge rates and lower waiting times.
National Enablers
- National investment and support to help reduce waiting times should be offered to primary care, including general practice and trusts. The elective recovery fund (ERF) provided by NHS England and NHS Improvement with additional government funding, has been an important catalyst to reduce waiting times for patients. The ERF understandably prioritises particular procedures but could form the basis of wider support for all providers, benefitting more patients.
- There remains a need for government to commit to an appropriate reward offer for staff across the sector. The NHS as a whole recently received the accolade of the George Cross. However, staff burnout, staff retention and the cumulative impact of exhausted teams across primary and secondary care, is a concern. There remains a pressing need for government to commit to an appropriate pay award which recognises the personal and collective contribution of NHS staff.
- National policy frameworks will need to keep pace with new pathways and more flexible working patterns. For example, consultant job planning, and associated contracting, will need to be refined to recognise new ways of working. This is especially crucial where discretionary additional work can create pension and taxation liabilities.