Plan to scrap tens of millions of NHS appointments ‘could put patients at risk’

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, NHS leaders and doctors are warning.

Health service leaders in England are finalising a radical 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, three or four 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 council at 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. He last month set out how hospitals could relieve the huge pressure they were under by slashing “on an industrial scale” the number of “pointless reviews” consultants carried out and 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 are 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 told a Health Foundation seminar last month: “We are kicking the tyres nationally on how we could do this on an industrial scale.” But he acknowledged that some patients, especially those who may not use a mobile phone or computer, including poorer and older people, could miss out on care as a result. Changes should be made while at the same time “making sure we don’t fall into a digital exclusion trap or exacerbate inequality by creating some mechanisms that [are] hard to access”, he added.

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

“If we can look after the patient properly, enable them to access things the way they want to and communicate with them appropriately we can make a significant impact on that.”

Reducing “pointless” follow-ups could be a “game changer” for the overstretched NHS, he added.

But, Wrigley said, “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 hospitals group 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, Royal College of GPs and NHS Confederation all warned that patients without a hospital follow-up could seek help at already hard-pressed GP surgeries.

Ruth Rankine, director of primary care at the NHS Confederation, said “effective communication” was needed to educate the public about the change and where in future they could see a doctor.

“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.

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