Treatment backlog is ‘public health crisis’ and a ‘big ask’ on GPs, NHSE director admits

Addressing the Covid-related backlog in treatment and restoring services is a ‘big ask’ for GPs, an NHS England director has warned, with the pent-up demand amounting to a ‘second public health crisis’.

Speaking in a webinar on Thursday evening (3 June), NHS England strategic incident director for Covid-19 Professor Keith Willett said there are many patients who are ‘desperate’ to get into hospital for planned elective care, adding ‘those waiting lists are going to be difficult to manage across both primary and secondary care’. 

A record five million patients were waiting to start hospital treatment at the end of March, including 436,000 who have seen appointments delayed by more than 52 weeks, according to the latest NHS England figures.

By comparison, in March 2020, there were 4.2 million patients on the waiting list, with just over 3,000 waiting for more than a year.

Professor Willett said: ‘We are now back into trying to restore services and I know in primary care and general practices that is a big ask because lots of people are coming out of the community who need care that didn’t get it previously – there’s a backlog building up there. 

‘That’s really our second public health crisis. The first one was the pandemic, the second one is the backlog of work that needs to be done.’

He added that managing patient expectations and prioritisation will be a big part of addressing this. 

Dr Irfan Malik, a GP partner in Nottingham told Pulse that GPs are ‘going to be caught in the middle between the patient and the hospital clinics’ due to the long waiting lists, as patients will go to their GP with symptoms, such as knee or hip pain when they ‘may be awaiting a consultation or an operation at the hospital’.

He said, however, that GPs ‘won’t be able to speed things up for them on the hospital clinics side of things’. 

Dr Malik added: ‘Like other practices, demand and workload has risen over the last six to eight weeks. All of that backlog is presenting, which we were expecting because people have been putting things off and haven’t been seeing GPs over the last year because of the pandemic.

‘Our referrals are increasing now back to pre-pandemic levels, if not more. We are also finding the wait for the outpatient clinics is very long. This non-Covid impact is going to be huge.’

Dr Sharon Raymond, a GP working for NHS 111, said the pressures built up in secondary care, due to the backlog, trickles down to other parts of the system, including general practice and then other primary care providers.

She said: ‘The backlog has an impact on services like 111, because if people can’t access the care they need [in general practice] in hours, they might have to call an unscheduled care provider. It has an impact across the system. 

‘Your own GP knows you best, and if you’re not able to access the care in primary care because of the pressures, and having to come to 111, then you may lose out on continuity of care. It looks like we are on the cusp of a third wave, which is going to put other pressures into the mix as well.’

In March, a BMA report warned that clearing the backlog of elective care to ‘more manageable’ levels could take up to a decade.

GPs saw more patients in March than in any other month since records began, according to NHS Digital data. 

NHS England previously announced a £120m boost to GP practice income for six months from April, which is, in part, earmarked for increasing capacity and tackling the backlog for chronic disease management.

However it has most recently been embroiled in a row with GP leaders over a letter which said all patients should now be seen face to face if this is their preference.