On demand elective care: Shortening NHS wait times through patient-centric pathways

Despite the work across the NHS, the number of patients on waiting lists for treatment has continued to rise to nearly 7.5 million in May 2023. This has been exacerbated by the impact of COVID-19 and waves of industrial action, but the NHS has been unable to meet the 18-week treatment target since 2016 nor the 62-day treatment target for cancer referrals since 2018. The NHS is already implementing programmes to address this, for example, through the new online matching portal that enables patients on elective waiting lists to find and schedule appointments at hospitals across the country. But with 96 percent of healthcare leaders saying that capacity is an issue, extensive waiting lists for elective treatment and specialist intervention feel inevitable – at least in the coming years.

Rather than increasing capacity through existing pathways, we need to continue to grow the ability for patients to choose and manage their own pathways – empowering them to make informed choices about their treatment journey to access treatment in the right place and at the right time for them.

Invest in new services and roles within Primary Care to expand patient choice

Patients see GPs for advice and peace of mind or immediate relief to bothersome symptoms – yet, for many patients, the GP may be unable to do either when specialist advice from secondary care is required. However, what if an appointment to refer could be avoided and, instead, the patient gets treated immediately? Removing the need for the GP to act as a gatekeeper to accessing other services within the NHS will not only relieve pressure on GP surgeries – it also frees up time to see, treat and manage those patients who – unless given adequate time with Primary Care – will require a referral to secondary care. It will also reduce referrals of patients whose condition has deteriorated due to waiting for that initial appointment and maximise the utilisation of the wide range of Primary Care services already available to the general public.

Take, for example, muscular skeletal (MSK) conditions that account for approximately 33 percent of GP visits. The implementation of First Contact Practitioners (FCPs) within Primary Care means that patients can self-refer and receive physiotherapy which, traditionally, would have only been made available following a referral to a physiotherapist in secondary care, as an outpatient. MSK conditions can present acutely and debilitatingly, impacting a patient’s ability to partake in everyday life, such as work. In such circumstances, a wait for a secondary care appointment can mean putting a patient’s life on hold – an unaffordable prospect for many in the UK, where statutory sick pay covers as little as 19 percent of the average national salary. Not only do FCP’s reduce referrals and appointment with secondary care, they allow a patient to get a faster resolution to immediate issues while freeing up GPs to see more complex patients. This, in turn, will further reduce the number of patients who are referred into secondary care.

The 2023 NHS Long Term Workforce plan goes some way in supporting this by diversifying entry routes into training placements and expanding multi-disciplinary roles. This needs to be carefully implemented and clearly aligned to patient need with a clear positive impact on the quality of care and experience for both the patient and the wider NHS workforce. However, further innovation in developing and embracing initiatives such as these will be vital in delivering care quicker and closer to home, alleviating pressures on secondary care waiting lists, and sparing patients from long waits for treatment.

Empower patients to self-refer into services and manage their own care pathway

The NHS has an ambition to deliver personalised care for patients that allows them more autonomy in their healthcare decisions. Giving patients more control is proven to improve their health outcomes, as well as increase engagement in self-management of their condition. And whilst progress has been made, for example, in enabling patients to order repeat prescriptions using the NHS App or monitor their insulin levels remotely, less has been made in other areas such as linking existing health data from your wearable devices (like your Apple Watch or Fitbit) which could have a significant impact for patients and the NHS more broadly.

It’s widely acknowledged that digitalisation is crucial to achieving sustainable healthcare. Creating joined up electronic health records, using advanced AI algorithms to prioritise patient appointments by need, and building applications to drive productivity improvement are key components to improving the provision of elective health services. For instance, what if scheduling processes were digitalised so that patients could self-book their appointments at a time that suits them or could review the status of their referral and how much longer they are likely to have to wait? Not only would such functionality reduce Do Not Attends (DNAs) (which, if reduced to two percent, would save the NHS £266 million), but it would make patients on a waiting list feel more in control and more informed– organising and managing their treatment.

Patients being able to organise their treatment plans is a good thing – using digital platforms to interact with specialists, check on wait times and book appointments at a time that works for them. This would also make patient communication with care providers more meaningful, as they would spend less time contacting their care providers about wait times and missed appointments. Co-designing solutions with your patients is an important stepping-stone in realising opportunities, as is ensuring that digital patient records systems have the agility to be compatible with future technology opportunities.

Utilise technology to automate pathways and empower patients

We need to be more ambitious - specifically when managing patients who could be supported without specialist input. We should leverage emerging technologies to perform rapid diagnostics and diagnosis in specialities such as dermatology and ophthalmology through apps, wearable devices or at home testing kits to make diagnostics accessible to patients. Many NHS organisations are already starting to set up advice and guidance where GPs take pictures of moles that are concerning the patient and send these in for specialist review or even use AI to diagnose potential skin cancer, which eliminates the need for the GP appointment and dramatically speeds up the time for diagnosis. What if this could be expanded to other high intensity services such as breast screening or to detect other cancers at an earlier stage?

And what if AI was taken further and used as a virtual advisory service, capitalising on the latest chatbot technology to provide safe, effective, and evidence-based advice that enables certain patients to start treatment themselves? As the NHS works to harmonise its Electronic Care Records and develop a platform to connect data across all healthcare organisations, work must be done to create a central, publicly accessible patient education and guidance tool. This would link likely treatment pathways with health conditions and symptoms, as well as outline the typical steps in the treatment journey for each of those pathways. Giving patients access to accurate and data-driven information will not only improve their understanding of their likely treatment plan but help them to navigate our complex healthcare system and access the right advice, guidance, and support at the earliest possible opportunity.

By minimising the wait time for diagnosis and streamlining patients who can be managed virtually, increased attention can be given to patients for whom specialist involvement will make a significant difference to their treatment and outcomes. This will not only reduce the volume of referrals requiring specialist input but improve the number of patients who can be treated at their first contact, reducing the number of follow-up appointments required to provide treatment.

Healthcare is evolving rapidly, and by thinking innovatively and applying long-term strategic thinking to invest in new services, empowering patients to own their treatment journey and using data to support patients to self-manage their own conditions, we can expedite and sustain the recovery of elective services.