Radical proposals designed to cut waiting lists would see patients being offered treatment in hospitals around the country where there is spare capacity.
It’s another development in a healthcare system which has experienced its biggest changes in decades as the effects of the pandemic are felt in every nook and cranny.
The post-pandemic backlog is now 5.8 million people and the latest proposals suggest that drastic action could help bring this backlog down to 2 million by the end of 2024, compared to a projected 8.4 million without the change.
The new proposals
So; what are these new proposals and is the country ready for them?
In a sense, what’s being outlined in a review led by Sir Jim Mackey, head of the Northumbria Healthcare NHS Foundation Trust, is not as momentous as the changes the country has already gone through over the past two years.
At the heart of the proposals is freeing up doctors’ time – which has been the real barrier to cutting waiting lists and increasing capacity in the NHS. One way of doing this is by slashing out-patient follow up appointments after treatment in a model called ‘patient-initiated follow-up’. Instead of automatic appointments, patients would be told to only contact doctors if they had a problem.
According to The Times, NHS sources have said there was “huge opportunity to free up clinical time” with some estimates saying it could reduce appointments by a third. That could translate to millions of potential appointments becoming available.
Whilst the shift away from face-to-face appointments is nothing new it is certainly not without its controversies. Primary care in particular has been facing an editorial narrative by media outlets condemning the use of telephone consultations in place of traditional in person appointments with GPs. Even the use of experts such as paramedics or clinical pharmacists has been viewed as ‘fobbing off’ patients with a substandard alternative – even if in fact the use of physiotherapists at a primary care level, for example, might be the best and quickest patient pathway. But without effective communication of the reasons behind these changes, patients were left to assume the reasons.
Better communication is a must
So how can these latest proposals be handled differently? Fundamentally, the answer lies in better communication.
Feedback from over 300 residents of Birmingham and Solihull for Healthwatch highlighted ‘poor communication’ as one of the main areas where health and social care providers needed to improve.
Based on their experiences over the pandemic and the shift in how services were offered, the lack of communication over delayed consultations, assessments and referrals were flagged by participants as one of their main complaints.
Patients are aware of the pressures the NHS has been under: of exhausted medical staff and the need for social distancing measures. What they are less tolerant of is not being informed of changes – and reasons for those changes.
But how can we address this, and what are the implications for patient-initiated follow ups?
There is a real risk that putting the onus on patients to get in touch with a concern will exacerbate existing problems in the health service, such as GP appointments and ambulance waiting times. A low-grade infection which might be picked up in a scheduled follow up could be left until it is well established in a post-operative patient who then requires an ambulance. Will a leaflet prevent that, particularly if the message the patients perceives is ‘don’t bother us, we’re busy?’ And what about those who cannot get through, with physical queues now replaced with busy phone lines.
Embrace all available tools
At the heart of this lies the need for providers to utilise multiple communication channels and provide information to patients so they are aware what is going on. Healthcare communication needs to switch from ‘transmit’ to ‘receive’, listening to what patients need and embracing the plethora of communication tools as wholeheartedly as it did remote appointments.
These tools need to be used for internal and external communications: platforms and messaging to ensure staff are aware of changes in procedure and services, and feel confident in communicating that to patients. That can’t be achieved in a once-a-month meeting but needs to be integrated into daily work.
And external communication to patients has to reflect the narrative being told nationally where patients have been encouraged to contact a medical professional with their health concerns. But it also needs to clearly state the different pathways available to patients, from pharmacies to walk in and specialist clinics.
A website hosting an old covid vaccine message and a sometimes-managed twitter account is not sufficient. But by investing properly in communications for staff, patients and stakeholders we can redefine how patients choose to communicate with the health service and rebalance patient demand; creating better patient outcomes and a positive industry in which to work.
By Annabelle S.