Elective wait list target met for first time in years amid A&G expansion

The Government last week hailed meeting the 18-week wait target for the first time in years, but the milestone comes amid warnings that workload is shifting to general practice.

In March, 65.3% of patients were waiting 18-weeks, as the waiting list fell by over 312,000 last year, the largest annual reduction in 16 years, NHS England said.

The last time the target was met was in 2021, and several policy organisations welcomed the move but said long-term sustainable reduction was far from certain and efforts had fallen short on other key targets, including cancer.

GP leaders also highlighted that this comes amid a rise in general practice workload via advice and guidance (A&G), and concern was also raised about list validation exercises leading to patients being removed from the waiting list.

Under changes to the GP contract for this financial year, GP practices are contractually required to use A&G across specialities ‘prior to or in place of a planned care referral where clinically appropriate’, with ‘single point of access’ routes to be finalised locally by 1 October.

And the latest figures show that in the first three months of this year, there were around 318,000 A&G requests a month.

Some of the most recent data is not yet available due to reporting time lag but in January there were almost 135,000 diverted requests, the data shows.

The overall waiting list has fallen to 7.11m, the lowest in three and half years.

The progress was achieved amid relentless pressure on frontline services including unprecedented numbers of GP appointments over the past year, health service leaders noted.

Dr Steve Taylor, GP spokesperson for Doctors’ Association UK, said any reduction in waiting lists was to be welcomed, but more detailed analysis shows that referrals are up, admitted treatments remain static and outpatient work is only slightly up and it was important that data truly reflected what was happening. 

‘There is concern that the data is showing that unreported removals and people being removed from waiting lists is a major contributor to the fall in waiting lists,’ he said.

‘GPs are aware of a number of patients who have seen their removal from waiting lists.’

Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said: ‘The data on NHS targets is positive news, but there are some important caveats. The increasing use of advice and guidance services, alongside greater GP involvement in supporting patients who require specialist input, will have contributed to the achievement of the 18-week target.

‘There also appears to have been an increase in patients being removed from waiting lists through validation exercises, such as confirming whether treatment is still required or whether patients still wish to remain on the list. Both factors are likely to have played a role in helping the NHS meet the target, alongside genuine increases in NHS activity.’

NHS England chief executive Sir Jim Mackey said it was a huge moment for the NHS.  

‘That our staff have been able to achieve this in a year that’s seen the busiest NHS winter on record, that’s been interrupted though industrial action and that’s since the biggest shake-up of the NHS in its history makes today’s achievement all the more extraordinary.’

Tim Gardner, deputy director of policy at the Health Foundation, said the figures showed the NHS had made significant progress but had fallen short of several other recovery targets for cancer and elective waits set for March 2026.

He added that four in 10 acute NHS trusts did not achieve the required 18-week improvements and ‘further targeted support will be needed to ensure an equitable recovery’.

‘The reduction in patients waiting for routine hospital treatment is welcome progress and reflects the extraordinary effort of NHS staff, particularly over a tough winter. But the real test will be whether this progress can be sustained and built on in the months ahead.’

Sarah Woolnough, chief executive of The King’s Fund, said meeting the target was a tribute to the hard work of NHS staff who have had to weather the headwinds of industrial action, increasing demand and the biggest reorganisation of the health service in over a decade.

‘Especially given this context, the health service’s leadership are rightly proud of what NHS staff have achieved for patients and the public.’

She said the £120 million in extra ‘sprint funding’  that had been funnelled into NHS trusts since January alone, to focus them on the elective waits target in a race to meet the March deadline would be hard to sustain.

And there were ‘opportunity costs’ to the approach with the priority given to meeting the elective target meaning ‘less focus on preventing disease, with the promised ‘health mission’ to kickstart a prevention revolution falling largely by the wayside’, she added.

Last month, shadow health minister and GP Dr Luke Evans went as far as accusing the Government of ‘massaging’ figures via A&G.