GPs raise patient safety fears over 25,000-letter hospital backlog

Exclusive At least 25,000 pieces of outpatient clinic letters from a hospital trust are currently waiting to be typed up and sent to GPs in one area, Pulse has learned.

GPs have been told this is due to a lack of admin staff following a ‘major restructure’ of the workforce at United Lincolnshire Teaching Hospitals NHS Trust (ULHT).

GPs in the area are deeply concerned about the situation, which they described as a ‘direct patient safety issue’ due to the possibility of patients not receiving required follow-up care.

ULHT confirmed to Pulse there is a letters backlog but said it had caused ‘no delays in patient care’.

However, GPs in the area – who said they learned of the issue via a hospital-employed ‘whistleblower’ who had said there was a backlog of 35,000 letters – challenged the claim that patient safety was not at risk.

One Lincolnshire-based GP, who wished to remain anonymous, told Pulse: ‘There could be 35,000 letters sitting there waiting to be dictated, all of which might involve prescriptions, might involve organising further tests, or organising further referrals – which is clearly a direct patient safety issue.’ 

‘We cannot mitigate the patient safety issues because we don’t know what the letters say. Patients are bad at remembering what they’ve been told so we can’t really act on the patients saying, “the specialist has told me I need this or that”, because we have no evidence to support that.

‘In terms of actual specific management as recommended by the specialist from an outpatient appointment, until we know what that is, we can’t do it.’

The GP further claimed to have several examples of patients who had seen a consultant several month ago whose hospital communication was yet to be received by the practice.

They also complained that since the restructure, GPs are unable to contact individual departments at the trust and must instead go via a single Patient Services Hub, which they claimed was ‘unresponsive’.

And they further raised concerns that the lack of admin staff could have an indirect impact on advice and guidance requests.

They said: ‘It is the consultants that do their own advice and guidance, but if they now haven’t got the support – if you think they have a personal secretary, and now the vast majority of them haven’t because it’s centralised, that’s going to have a knock-on effect.’ 

The hospital trust confirmed to Pulse that there was 25,000 overdue outpatient clinic letters, but denied that it had led to any treatment delays. They also said the issue did not affect A&G.

A ULTH spokesperson said: ‘Lincolnshire Community and Hospitals NHS Group is in the middle of a major transformation programme of its patient administration services in line with the ambitions set out in the NHS 10-year plan.

‘As part of implementing this new approach, we had always planned to address a historical issue relating to 25,000 overdue outpatient clinic letters which are awaiting typing. Our transformation programme was specifically designed to address this issue.

‘There have been no delays in patient care provided by the Trust as a result of this issue as patients have continued to receive assessment, treatment and clinical decision-making at their appointments, and any urgent actions, referrals, investigations or medication changes are communicated and implemented at the point of care.’

They added that the trust is working on improving communication with general practice.

The spokesperson said: ‘We recognise that timeliness of communication with general practice is also important for onward management of patients and we are committed to improving this, hence the transformation of our patient administration services.

‘We will continue to work in partnership with local GP colleagues during the transition to our new system. A robust plan is in place to risk assess the backlog. We have already begun this work and will ensure it is completely cleared within the next 12 weeks.’

Lincolnshire LMC medical director Dr Reid Baker told Pulse: ‘This reported backlog of letters at United Lincolnshire Teaching Hospitals Trust regarding patient appointments and treatments was raised by practices to us [on 9 June]. We contacted the hospital trust and are awaiting clarification.

‘If there are a backlog of letters, practices and any affected patients need this remedied promptly by the hospital trust to avoid potential impacts on GP practice care for those patients to whom any delayed letters relate.’

A Lincolnshire ICB spokesperson told Pulse: ‘We are aware of the concerns raised and are in active discussion with ULTH as they implement their wider transformation of patient administration services, which, amongst other things, will address overdue outpatient letters.  

‘The Trust has assured us that patient care has continued as normal and that urgent clinical actions are communicated at the point of care. We recognise the importance of timely communication with general practice and expect all providers to have robust arrangements in place to support this. We will continue to work with ULTH and to minimise any impact on primary care and patients.’ 

Pulse has previously reported extensively on the national issue of ‘missing letters’, with hospital trusts across the country having failed to deliver at least 724,000 patient letters to GPs.