Months-long waits for urgent cardiac referral a ‘national disgrace’

Exclusive Patients are being put at serious risk of harm by lengthy cardiac clinic waits for suspected chest pain despite an urgent referral in what amounts to a ‘national disgrace’, GP experts have said.

Patients used to be seen in Rapid Access Chest Pain Clinics within two weeks but GPs around the country have told Pulse that it now takes many months before patients are seen.

The urgent access clinics were first put in place more than two decades ago for patients with suspected angina as part of a national framework to improve outcomes from heart disease.

But GPs say that the progress made has been lost and the system has become ‘unsafe’.

Professor Derek Connolly, council member of the Primary Care Cardiovascular Society, and consultant cardiologist at Birmingham City Hospital said his trust was still managing to meet two-week targets, but teams around the country were struggling to have capacity to cope with the increased demand that had been seen since the pandemic.

‘We have long waits for diagnostic tests such as CT because there are not enough scanners. I think it is a national disgrace that this is not being given the priority it should be. There is no capacity and it is very frustrating.

‘In terms of years lost, heart disease is the number one killer and the evidence is we should be getting in early and finding patients who would benefit from treatment. Rapid Access Chest Pain Clinics should be given the same focus as other areas such as cancer and it needs investment.’

Dr Dave Triska, a GP in Surrey, said when he last looked the waits were more than four months for patients with explained chest pain to be seen. He added it was ‘terrible’ for patients and would lead to ‘serious harms’. He knows of patients who had been admitted to hospital straight from the clinic as the results were so bad.

Professor Carolyn Chew-Graham, a GP in Manchester said patients waiting up to six months in her area. ‘There are very long waits, it is absolutely not rapid.’

In Nottingham the wait can be up to six months and that has changed how they approach referrals, said Dr Irfan Malik, a GP in the city. ‘If a patient has chest pains we send them to A&E or call 999. If it’s less acute and we think angina then we refer to a normal cardiac clinic which can also take several months. It is pointless having a rapid access clinic if it’s not rapid.’

In Lincolnshire waits are also currently six months, Dr Phil Williams, a GP in Lincoln, told Pulse.

‘The frustration with having a six-month wait is that you find yourself directing more and more people with new onset angina to A&E, further increasing pressure on the hospitals. However, if someone is having angina most days, there’s just no other safe option,’ he said.

Dr Selvaseelan Selvarajah, a GP in East London said the two-week wait for unexplained chest pain used to be the gold standard. ‘Now, the waits can be two months. There is also an additional wait between the time patient is seen and investigations. This creates further delay to eventual patient care.’

He added that while two months was less than patients were experiencing in other areas – probably because they had one of the largest cardiac centres in the UK on their doorstep – it is still far too long. ‘We ought to treat this with the same urgency as suspected cancer referrals.’

Dr Steve Taylor a GP in Manchester and spokesperson for Doctors Association UK noted that there are no published waits on rapid access chest pain clinics but he can see the estimates of waits when doing electronic referrals.

‘Currently referring a person for an assessment of suspected angina and the best locally is 47 weeks and best nationally 15 weeks, 200 miles away,’ he said. ‘This was and should be two weeks. It is impossible and unsafe for patients and GPs.’

Professor Azeem Majeed, a GP in South London said they had also noticed a deterioration in waiting times from two to eight weeks.

‘The other problem we have with the clinics is that many referrals are rejected. This is sometimes even the case after a patient has attended A&E and a referral has been recommended.’

Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation (BHF), and consultant cardiologist, said: ‘Every minute counts when you have a heart attack or stroke, yet we continue to see extreme delays to ambulances responding to these life-or-death emergencies.

‘At the same time, waiting times for planned heart treatment are still at a near-record high. Left unchecked, long waits for time-sensitive heart care can lead to avoidable deaths or disability.

‘It deeply troubles me that delays and cancellations to potentially life-saving heart care are becoming normalised, and almost expected. Patients and their families must see an end to this crisis soon.’

Studies have shown that heart disease is one of the main driving factors in an ongoing level of excess deaths recorded since the pandemic.

NHS England was contacted for comment.