It may be many years before all the people on specialist waiting lists are assessed in the wake of the last year’s pandemic response. In general practice we don’t concern ourselves with the mechanics of waiting list management but we are concerned by the length of time people wait for specialist care and the potential for physical and psychological harm this causes. This in itself creates a sizeable workload in general practice, supporting and helping patients to manage their conditions and anxieties as they face a long wait. Like general practice, our secondary care colleagues have adopted alternate forms of consultations very quickly. But this is unlikely to be enough.
So the waiting list isn’t just a secondary care problem. It’s doubtful that the solution to the ‘backlog’ lies solely in speeding up the conveyor belt or adding more conveyor belts. I would argue that a waiting list backlog needs a population health approach. After all, these are an identified group of people with, in some cases, similar needs. Perhaps part of the solution lies in a system-wide approach to identifying these needs and creating system wide solutions that could involve specialists, a range of primary care clinicians, care navigators, therapists, coaches, mental health workers and maybe others.
We don’t exactly have a surplus of clinicians in the system but ICS and commissioners need to look carefully at the wider solutions and resources needed for what is likely to be a long-term problem. The solutions themselves may help to pave the way for real integrated care rather than structural changes and pseudo-integration.