Flushing out the work backlog could get messy

You’ll vaguely recall that there’s been this virus going round. And you’ll also know this has resulted in a backlog of work in secondary care – more accurately, a complete faecal impaction, with the overflow landing messily in our laps. 

Well, the enema has finally arrived. It’s the Government’s awkwardly titled ‘Elective recovery planning supporting guidance’, and it aims to flush away those lengthy waiting lists.

Which sounds good. Because at the moment, when we’re literally or metaphorically stuck with a patient, we have two options. Advice and Guidance (A&G), increasingly a cynical bounce-back of work and responsibility, or referral, a pointless exercise outside of the urgent two-week wait scenario unless the patient goes privately, which might be business-as-usual in leafy Surrey, but isn’t in grimy Essex.

So what do we see as we stare down the enema barrel? A 30% expansion in activity in the next three years. Yay! 

Hang on, though – that increase is largely through ‘more pathways completed in primary care with the support of specialist advice’. No yay. 

Worse still, this referral avoidance process (their words) will be monitored or policed by the elective recovery outpatient collection aka EROC. And if they think that sounds sexy, it doesn’t, because it leaves me frigid with fear and will leave patients cold, some of them literally.

And there’s more. Specifically, a 25% reduction in outpatient follow-ups. Don’t worry, though, this ‘see and discharge’ policy won’t leave these patients lost and unsupported. No, they’ll be rescued by another wacky acronym: ‘patient-initiated follow-up’ (PIFU). Forget ritualistic, pointless appointments patients don’t need. Instead, they can be all flexible and empowered, knowing that they can arrange a specialist review as and when. Which would be fine if anyone in secondary care ever answered a phone call, an email or a howling at the hospital gates, but they don’t, so PIFU is PIFL.

The coup de grace is the genius explanation that the time saved by consultants preventing unnecessary follow-ups will create space for them to do more A&Gs. Which means that, by stopping seeing patients they can create the necessary time to stop seeing more patients. 

So what we have here is dump and dumper. I know we moan about workload, but not only does this plan leave us overloaded, it leaves us marooned. And I guarantee there will be two further things to wind us up and grind us down.

First, someone will offer ‘resources’ to ‘support’ us with the recovery plan, and assume that solves everything. It doesn’t, because we don’t need money, we need time, and – contrary to popular belief – the one doesn’t buy the other. And we certainly don’t need the extra responsibility.

Second, remember how the BMA tried to stop workload dump with stern words, contractual promises and official bounce-back templates, and remember how hospitals just laughed in our faces? Somehow, now the bounce-back boot is on the secondary care foot, I suspect the process will suddenly be taken very seriously, and imposed. 

Sorry to be the bearer of grim tidings. But this is in danger of becoming a real battle – and one of the key rules in any conflict is, of course, know your enema.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs here