The majority of doctors think ambitions to get the NHS back to near-normal service by autumn are unlikely to be realised, according to a major survey1 by the British Medical Association, highlighting the sheer scale of the challenge of tackling an ever-growing backlog of care after the first peak of Covid-19.
NHS England recently set targets to resume normal levels of activity over the next few months2, but when asked by the BMA whether they thought these would be met, 70% of more than 3,000 doctors who responded said this was either highly (40%) or fairly (30%) unlikely3.
Meanwhile, the scale of the backlog built up during the pandemic has been laid bare, with a third of doctors saying they thought it would take more than a year to clear waiting lists for elective procedures4.
Other key findings from the BMA’s latest tracker survey of doctors in England and Wales include:
- 60% of doctors said they were not very or not at all confident in their local health economy managing demand as normal NHS services resume5.
- Half of doctors said they were not very or not at all confident in being able to manage a second wave of Covid-196.
- 26% of doctors said that in the last two weeks non-Covid demand had increased to pre-pandemic levels, with 17% saying that demand is now even higher than it was before7.
The survey results come after NHS figures on Thursday showed record waits in a number of areas, including the wait between being referred by a GP to first treatment, and the number of people waiting longer than a year for treatment rising to the highest in over a decade.
BMA analysis8 of the latest figures also show regions that are particularly impacted, with Dorset and areas in the North East and Essex facing the longest waits for treatment at 20 weeks or longer9.
Patients should wait no longer than 18 weeks from referral by a GP to treatment in England, and the national target is to have 92% treated within this timeframe. However, statistics this week showed that nationally, only 52% were, and the BMA analysis shows that in one area this figure was as low as 38%10.
Dr Chaand Nagpaul, BMA council chair, said:
“These survey findings underline the sheer scale of the challenge for the NHS in the coming months, and the anxiety and concern felt by already exhausted frontline doctors as they look ahead to what will likely be one of the most challenging times of their careers.
“Although staff are being told that the NHS will begin to return to ‘business as usual’ they have little confidence that it will be able to cope with the backlog of millions of patients left untreated during the first spike of the pandemic. Doctors are worried for their patients and the risk of their condition deteriorating as a result of further delays, given that more than 50,000 patients are already waiting longer than 12 months for treatment – 46-fold the number from a year ago – and 45% of doctors told us they are seeing patients presenting later than before with their symptoms11.
“At the same time, doctors are really fearful of how the NHS will cope if a second wave of Covid19 hits, which could be devastating for the health service if it arrives in winter and amid a potential flu outbreak.
“We must do all we can to avoid another peak now, focusing on prevention, and maintaining clear, consistent public health measures and messaging.”
Dr Nagpaul added:
“The most recent waiting time data speaks for itself, with patients waiting unacceptably long times for treatment. But the Government and NHS England also need to be honest with both healthcare staff and patients about the backlog we’re facing. They must produce a clear strategy of how we can manage this increased demand, working with clinicians to prioritise those patients most in need of care, while at the same time being able to continue treating people who are still suffering with Covid-19. And crucially, doctors do not want patients avoiding the health service and risk getting much sicker as a result.
“We must learn lessons from the last few months, including making the most of technology and cutting down on burdensome bureaucracy that takes doctors away from treating patients. It is also vital that we continue to make efforts to retain as many staff as possible, including those who have returned to the NHS during the pandemic, and protect their safety and wellbeing.
“Doctors need to be given the opportunity to rest and take care of their wellbeing alongside tackling the backlog of care – we cannot have tired and ill doctors treating patients. And they and their employers shouldn’t be penalised if they cannot meet these targets.
“This pandemic has brought sharply into focus how underfunded and understaffed the health service has been in recent years. Now is the time to address this and properly fund the NHS, increase staffing numbers and give it the resources and capacity required to meet the needs of patients not just in the wake of a health emergency but in the long-term.”
Notes to editors
The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
- 4,279 doctors in England and Wales took part in the survey between 6 and 12 August. See PDF for breakdown of results referred to above. Further results will be published on the BMA website soon.
- These targets included: returning to 80% of normal activity levels for outpatient/daycase procedures in September, rising to 90% in October; and returning to 100% of last year’s activity for first outpatient attendances and follow-ups (face to face or virtually) from September. Full details here.
- When asked “how likely is it in your view that services in your local area will be able to achieve these targets?”, of 3,326 respondents, 40% (1,339) said it was highly unlikely and 30% (997) said it was fairly unlikely.
- When asked “assuming there are no future Covid spikes, how quickly, if at all, do you believe your department / practice / place of work / local health economy will clear any backlog / waiting lists of patients who would otherwise have been seen or treated during the pandemic period?”, of 3,486 respondents, the largest proportion – at 34% (1,171) – said it would take longer than a year to never to clear this for elective procedures, while 33% (1,164) said it would take 3-12 months.
- When asked “How confident are you about your ability to manage patient demand [in your local health economy] as normal NHS services are resumed?”, of 3,650 respondents, 23% (838) said “not at all confident” and 37% (1,345) said “not very confident”.
- When asked “How confident are you about your ability to manage patient demand if there is a second peak of Covid-19 (national or local)?”, of 3,714 respondents, 21% (768) said “not at all confident” and 30% (1,107) said “not very confident”.
- When asked “Within the last two weeks, what change, if any, have you experienced in the level of non-Covid patient care?”, of 3,705 respondents, 17% (629) said “level increased, now considerably higher than pre-Covid”, while 26% (974) said “level increased, back to pre-Covid level”.
- The BMA has analysed the referral to treatment data, currently reported by NHS Trust, Clinical Commissioning Group (CCG) and CCG region, to organise it by Integrated Care System (ICS) and Sustainability and Transformation Partnership (STP), to give a more complete regional picture. There are 42 ICSs (Integrated Care Systems) and STPs (Sustainability and Transformation Partnerships) across England, each of which brings together NHS, local authority, and third sector bodies to plan and co-ordinate care across their area. Please see spreadsheet for the data.
- The median referral to treatment time for Dorset ICS, Mid and South Essex STP, and Humber, Coast and Vale ICS were 20.4 weeks, 20.3 weeks and 20 weeks respectively.
- Dorset ICS had a 38% average performance against the 18-week target, Mid and South Essex STP had 42% and Northamptonshire STP, and Humber, Coast and Vale STP both had 44%.
- When asked whether, within the last two weeks, they had seen or treated any patients presenting with conditions at a later stage (e.g. cancer, heart disease) than they would normally expect, of 3,726 respondents, 45% (1,688) said “yes”, 35% (1,294) said “no”, 9% (325) said “don’t know” and 11% (419) said “not relevant”.