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Follow-Up Patients and the NHS 'hidden waiting lists'

It has been several years since we last published our blog on ‘hidden waiting lists’, but a BBC article published on the 19th of February brought this topic back into the spotlight.


In the article an NHS England spokeswoman stated that "National guidance is clear that if a regular follow-up review or treatment becomes overdue and a patient is waiting longer than the time agreed with their clinician, they should be added back on to the waiting list and therefore would be included in published figures."


Whilst this mandate was conceived with the best of intentions, specifically to ensure that Trusts did not lose focus on patients overdue a follow up, within the current climate, observing this mandate is simply untenable.

A typical Trust will have around twice as many patients awaiting a follow up as they will patients on the PTL, and you would expect in many cases that 50% of these will be overdue. In this case, the national RTT PTL would double in size instantly if this were observed.


Furthermore, Trusts have many measures and controls in place to manage follow up care, that factors in condition, and likelihood of clinical risk, often prioritising patients in this way. Not to mention PIFU initiatives and other workstreams to improve how follow up care is managed.


Many Trusts see RTT patients and follow-up patients as binary, with each cohort being managed separately, and differently. This is entirely appropriate and results in better outcomes for the patient and the Trust.

De-stabilising this paradigm would cause absolute chaos, that would doubtless result in more patient risk, more clinical harm, longer waiting patients, and an enormous operational overhaul.


Even if a target exists on paper, and with the best of intentions, the consequences of enforcing the target must be considered, and Trusts must be consulted.


As such, whilst there may be an issue with the visibility of follow up patients, placing them on an RTT pathway is a cure far worse than the disease.


We can support Trusts in managing their follow up backlog with our Clinical Protocol Validation Solution. Through this programme, we have supported 3 Trusts across 8 specialities place 30% of patients on PIFU, discharge 10% of patients, and escalate 1% for urgent attention.


If you would like to discuss how we can support your Trust, contact us to find out how we can help you.



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