Long hospital waiting lists create ‘avoidable’ GP workload, says CQC chief

Hospital backlogs mean that GPs are having to manage people on waiting lists for longer creating ‘avoidable’ workload, the CQC’s chief executive officer has said.

Ian Trenholm’s comments came during a presentation of the CQC’s new report on the state of health and adult social care in England, which looked at the quality of care over the past year.

The report found that the number of people on waiting lists for treatment ‘has grown to record figures’, with over 7 million people on elective care waiting lists in June – but said that the true number ‘could be much higher’, as some people who need treatment are struggling to get a referral from their GP.

In response to a question asked by Pulse, Mr Trenholm said that one of the results of longer waiting lists is that GPs are having to manage patients while they wait to receive care.

He said: ‘I think we recognise the vital role that GPs play and I think we recognise in the report the enormous work and fantastic work that GPs have been doing this year and we also recognise that some of the challenges in the GP sector are a direct consequence of challenges elsewhere in the health and care system.

‘We know that backlogs in hospitals mean that GPs are having to manage people on waiting lists for far longer than either the patient or the GP would like.

‘So there’s an element of work that is being done by GPs which is potentially avoidable if waiting lists were shorter.’

The report also pointed out workforce challenges in general practice, with GP providers ‘having difficulty recruiting’, and many practices ‘increasing their use of roles such as paramedics, clinical pharmacists, advanced nurse practitioners and physician associates’ who ‘add value to general practice teams in terms of speciality’ but ‘require supervision and support to carry out their roles’.

The CQC warned that the danger is that the combination of workforce challenges and the cost of living crisis ‘exacerbate existing heath inequalities’, increasing the risk of a ‘two-tier system of health care’ where people who cannot afford to pay could end up waiting longer for care while their health deteriorates.

Dr Latifa Patel, BMA representative body chair, said: ‘The experiences of staff, their declining wellbeing and the impact that this has on care are spelled out clearly: they are “overworked, exhausted and stressed, sometimes to the point of becoming ill, injured or leaving their job altogether”.

‘This exhaustion is both a symptom and cause of huge workforce shortages, and the result of a failure to get a grip on the retention of doctors and our colleagues across the NHS and social care. 

‘Sadly, but inevitably, and despite individuals’ best efforts in our GP practices, hospitals and across the NHS, these workforce shortages increase waiting times for people needing care.

‘And worryingly, staff have raised that the stress and burnout caused by this understaffing makes mistakes and poor care more likely.’

Sally Warren, director of policy at The King’s Fund said: ‘The report shows the multiple crises the Government will have to address if it wants to get health and care services back on track.

‘Achieving that will require bold action to prevent illness, measures to make health and care a more attractive career, and bolstering out of hospital care such as GP, community and social care service.

‘Public satisfaction with the NHS is at a record low. Despite this, and despite signs that some people are paying for care out of their own pocket while others simply go without, public support for the founding principle of services being free at the point of use remains rock solid.

‘History has shown us that a slow slide towards a two-tier health service can be avoided through a concerted effort to bring down NHS waiting lists, led and funded by Government.’ 

Parliamentary and Health Service Ombudsman Rob Behrens said: ‘This report makes for extremely difficult reading. Our healthcare system can’t keep up with the rising demand for care.

‘With more and more people having to turn to private healthcare a two-tiered health system has been created where, too often, only those who can afford it, are able to be treated quickly.’

Last week, Pulse reported that more patients are paying to see a private GP due to longer NHS waiting times, with a private GP provider reporting a surge in the number of people requesting its services.

Last month, the CQC quoted lack of capacity to meet patient demand among the reasons for placing a group of GP practices in special measures.

The CQC is to roll out a new assessment framework from next month, which will still involve ratings and five ‘key questions’.