ICBs have been told the first steps they must complete as part of the elective reform plan to reduce waiting lists, which has been published by the government today.
In a letter to ICB chief executives and chairs, NHS England called on them to take three ‘steps’ ahead of the next financial year.
These included naming a director who will be responsible for improving the experience of care and waiting for care; reviewing and improving the operational processes that affect how patients and their carers receive correspondence and access to information on waiting times; and making customer care training available to non-clinical staff with patient-facing roles.
The letter, from chief operating officer of NHS England, Dame Emily Lawson, and national director of elective recovery, Sir James Mackey, said ICBs would receive another letter ‘shortly’ setting out the ‘approach’ to the remainder of the financial year, reflecting the funding adjustments from the autumn budget.
It comes as Prime Minister Sir Keir Starmer this morning laid out his elective reform plan which ‘sets out a whole system approach’ to meeting the 18-week referral to treatment target by the end of this Parliament.
These plans include paying GPs in England £20 for undertaking advice and guidance (A&G) with hospital specialists to prevent ‘unnecessary referrals’, with 800,000 more patients managed in primary care annually, rather than secondary care.
The reforms also include the ambition to expand the use of community diagnostic centres (CDCs), opening the centres for longer and expanding the range of tests available, and to expand the NHS App to improve information and appointment management for patients.
NHS England said it will work with ICBs and trusts to:
- Support the optimisation of Advice and Guidance (A&G), including by implementing changes to the payment scheme to support GP practices to manage in the community those who do not need secondary care,
- Continue to roll out patient initiated follow-up and remote monitoring in appropriate pathways, to avoid unnecessary attendances,
- Extend adoption of the Federated Data Platform (FDP) to 85% of all secondary care trusts, to maximise the benefits seen in early adopters from waiting list validation, scheduling and theatre optimisation,
- Support more consistent use of the independent sector to increase capacity and choice for patients,
- Continue working towards greater connectivity between the e-Referral System, patient engagement portals and the NHS App, so patients have more control over their appointments and to improve the productivity of clinic booking,
- Continue to support the delivery of new community diagnostic centres and surgical hubs, including working with you to optimise their productivity.
It added that NHS England would also continue to ‘realign its resources to support productivity and operational improvement including:
- Updating the finance and payment scheme to reflect elective priorities,
- Running a capital incentive scheme for providers who improve the most in meeting referral-to-treatment (RTT) standards,
- Further developing the NHS IMPACT Clinical and Operational Excellence Programme, to provide training for at least 8,000 clinical and operational leaders, and to spread proven improvement approaches for elective reform,
- Strengthening elective performance oversight, including through tiering and the new NHS Oversight and Assessment Framework,
- Developing clear standards and metrics for the administrative and operational delivery of elective care,
- Developing expectations for local clinic templates and job planning, to clearly set out the types and balance of activity clinicians should be undertaking, including sessions within the community.
Source: NHS England letter
The letter to ICBs on the plan said: ‘We do not underestimate the scale of the challenge to return to constitutional standards for elective care, nor what it has taken over the last three years to recover long waits.
‘Thank you again for those huge efforts made to date, which have meant that hundreds of thousands of people have received care more quickly than they otherwise would.’
In response to the plan, NHS Confederation chief executive Matthew Taylor said: ‘NHS leaders share the government’s ambition to reduce waiting times and get more people off what have often become very lengthy waiting lists.
‘This updated elective plan is a serious attempt to reduce waiting lists in a more sustainable way and marks an important step forward in helping bring an end to a period of long waits.’
He added that the plan is ‘underpinned’ by measures that will ‘ensure efforts to reduce waiting lists align with the major shifts in care’.
‘These measures include empowering patients with better data and choice, redesigning pathways and increasing focus on advice and guidance which can help to deliver better outcomes for patients, investing in secondary prevention and focusing on the specialist clinical areas where the biggest gains can be made,’ he said.
‘It is also important to see more collaboration with the independent sector as this will provide much-needed support and capacity.’
However, he added that local leaders needed confidence that they will have the funding to deliver the targets.
Dr Caroline Taylor, GP and chair of NAPC, welcomed the additional funding for advice and guidance, but added that the policy ‘needs to recognise that it is much more than easing the important links between primary and secondary care, it needs to include a recognition of managing the expectations/excess demand and outcomes of advice and guidance’.
She added: ‘However, NAPC has long championed joined up primary care central to the benefit to NHS Colleagues and populations that they serve and by offering alternative healthcare interventions in a community setting, delivered by a neighbourhood team will empower patients and clinicians to have greater control over receiving and delivering healthcare.
‘All too often we see a number of our patients struggling in pain and unable to cope with everyday living while they wait for an operation. This, along with the reintroduction of the 18 week target for those most in need of a surgical intervention, is good news for patients and their carers.’
Tim Gardner, assistant director of policy at the Health Foundation, said it also welcomed the plan to tackle waiting times.
However, he warned they should be under ‘no illusions’ about how ‘stretching’ the targets in the plan are.
‘The aim for 92% of patients to receive hospital treatment within 18 weeks of a referral by the end of this parliament is highly ambitious and hasn’t been met for nearly a decade,’ he said.
‘To achieve this, it would effectively mean the waiting list would need to fall by over 3 million over the next four years. Meeting the pledge would require improvements of a comparable scale to those achieved by the last Labour government in the 2000s, but in more difficult circumstances and with far lower levels of funding increases.’
It comes as the Government last month unveiled the first details of the next GP contract, including an extra £889 ‘on top of the existing budget’ for general practice.
