NAO warns NHS against ‘overloading’ GPs in clearing elective backlog

The NHS needs to work out how GPs can help clear the elective care backlog without ‘overloading’ them, Government auditors have warned.

One of the challenges to growing NHS activity to eliminate the backlog will be working out ‘how best to use GPs without overloading them further’, a National Audit Office (NAO) report said.

The report, which focused on elective and cancer care, noted that GPs ‘often have to offer additional support to patients facing long waits’ which places ‘further strain on the NHS’. 

It said that for elective care, around 30% of patients are discharged back to the care of their GP after the first outpatient appointment.

The elective care waiting list could reach 12 million by March 2025, the report also warned.

This would occur if half of missing referrals – people who did not present due to the pandemic – return to the NHS and activity grows ‘only in line with pre-pandemic plans’ of a 3.2% annual increase, the report stated.

If 50% of missing referrals return and the NHS is able to increase activity by 10% more than originally targeted in the Long Term Plan, seven million people will still be on the waiting list by March 2025.

The NAO estimated that there were between 240,000 and 740,000 ‘missing’ urgent GP referrals for suspected cancer during the pandemic up until September 2021, as well as between 7.6 million and 9.1 million missing referrals for elective care.

The report, published today (Wednesday 1 December) added that it is unclear how many ‘missing’ cases will go to the NHS for treatment and over what period of time. As well as ‘missing’ cases, new demand may arise from things such as long Covid.

In March 2019, 1.74 million new patients were referred for elective care, with GPs making the most referrals (60%), the NAO report said.

Meanwhile, although NHS cancer services were functioning at pre-pandemic levels in June 2021, in September only 68% of patients who had been urgently referred by their GP as needing treatment within 62 days had begun treatment in that time bracket.

It comes as Sajid Javid promised the Government would publish its plan on how to tackle the elective care backlog by the end of November.

RCGP vice chair Dr Gary Howsam said: ‘It must be remembered that NHS pressures are not confined to secondary care and it’s crucial that any efforts to alleviate the backlog in hospitals also account for the increased pressure the backlog is placing on general practice.

‘GPs and our teams make the vast majority of patient contacts in the NHS, and whilst patients are waiting for operations or specialist consultations, the responsibility for their care and management of their conditions usually falls back on GP teams.

‘GPs take our responsibility to refer appropriately very seriously and we worked hard throughout the pandemic to continue to refer patients with possible symptoms of cancer in as timely a way as possible.’

And he added that whilst there ‘was a drop in urgent cancer referrals at the start of the pandemic, which evidence shows was mainly due to people following official guidance to stay at home, as well as concerns about catching Covid-19 and overburdening NHS services’, referral rates ‘from March to the end of August this year exceeded pre-pandemic levels’.

BMA council chair Dr Chaand Nagpaul said: ‘This is an unacceptable situation and must act as a wake-up call to Government to start giving the NHS the support, resources and capacity it needs before more people endure more untold pain and distress.

‘The backlog is growing day-by-day and tackling it is now long overdue – but staff are exhausted and therefore there must be honesty from politicians around the situation we’re in.

‘For GPs, they are working as hard as they can to meet patient demand, being deluged with patient queries about their hospital waits and appointments, and are delivering more appointments than before the pandemic.’

Professor Azeem Majeed, GP and professor of primary care at Imperial College London, told Pulse the report shows ‘the vast scale’ of the problem facing NHS England, ‘from the impact of Covid-19 on NHS activity but also through 10 years of a very slow increase in NHS funding’.

He said: ‘Trying to address the backlog will be a long-term challenge for the NHS and will be difficult to until the Covid-19 pandemic is under control and without additional funding and staff.

He added: ‘The backlog of work also impacts on primary care as many people are left to be managed by primary care teams whilst awaiting their hospital appointments.’

In June, NHS England said GPs and hospitals must ‘jointly manage’ patients stuck in the backlog of care caused by the Covid pandemic.

Meanwhile, the England LMCs conference voted last week for a ban on hospitals making ‘advice and guidance’ mandatory as part of their referral management procedures.

Two major London hospital trusts are currently trialling reducing referrals by mandating A&G.