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18 week wait target worsens chronic pain suffering

By Nigel Praities

The Government's flagship waiting time target is increasing the suffering of many patients with chronic pain, by distorting clinical priorities, a new study reports.

Patients referred directly from a GP to a pain clinic are being seen more quickly than before introduction of the 18-week referral to treatment target, but those referred from within hospital are often left stranded for months without care, researchers found.

Their study uncovers a darker side to latest Government figures showing an increase in the numbers of patients seen within 18 weeks, with three-quarters of admitted patients and 86% of non-admitted patients being treated inside the target time.

The audit of patients attending a pain clinic at Solihull Hospital found that average waiting times for direct GP referrals to a pain clinic fell between 2000 and 2007, from 17.9 weeks before ministers brought in waiting time targets, to 8.7 weeks after 2003.

But waiting times for those referred from within the hospital increased from an average of 43.2 weeks to 78.7 weeks for the period after 2003, according to data presented at the British Pain Society annual conference in Liverpool.

The researchers said the 18-week target for referral to first treatment, introduced in 2004, was forcing hospitals to fast-track direct referrals from GPs while leaving limited resources for those referred after seeing a specialist.

Study leader Dr Barbara Hoggart, pain management consultant at Heart of Birmingham PCT, said Government figures distorted clinical priorities and left some patients with chronic pain to wait a long time for treatment. ‘Priority is given to direct referrals and in-house referrals are not given the same priority,' she said.

Dr Donal Hynes, a GP in Somerset and a member of the steering committee of the Primary Care Rheumatology Society, said the study highlighted the distortions in care that top-down targets produced: ‘This is the danger with targets, that it just hides these patients away and people take their eye off the ball,' he said.

Dr Hoggart suggested GPs should be aware of the problem and try to refer patients directly to a pain clinic or initiate analgesic treatment early.

But Dr Hynes disagreed, saying the system needed to change, with consultant to consultant referrals removed and pain management clinics shifted into the community. ‘Consultants have a very specialist view, whereas GPs have a more holistic view of a patient. Pain clinics run by GPSIs could cut waiting times,' he said.

Hospital How targets distort GP referrals How targets distort GP referrals

May 08 – Study reveals patients not under the 18-week target wait much longer to be to be seen by pain clinics
Apr 08 – Pulse reveals hospitals are forcing GPs to write referral letters for transfers from one consultant to another to boost income from the Payment by Results system
Feb 08 – Pulse reveals 90% of hospital trusts have cut the number of weeks appointments can be booked in advance by GPs on choose and book, to meet the 18-week target
Sept 07 - Department of Health statistics show only about a half of patients come in under the 18-week threshold
Aug 06 - Pulse reveals patients are being denied appointments at popular hospitals that cannot offer appointments in time to meet waiting targets

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