It goes without saying the waiting-list crisis is having a direct effect on patients.
It is increasing the burden of pain, medication and anxiety for those awaiting investigations.
It is increasing disability as a result of the conditions they are awaiting treatment for.
We are seeing patients dying while waiting on lists or being diagnosed with other conditions which then preclude the procedures they have been so desperately waiting for.
We are seeing patients awaiting red flag assessments being admitted to hospital and receiving their diagnoses as inpatients or via emergency departments because of delays to pathways.
As GPs we are seeing an increase in pressure on our services, dealing with repeat consultations for the same problems for which patients are awaiting secondary-care assessment.
This is inevitably affecting access for other patients not on waiting lists. Daily queries about waiting lists are affecting the work of administrative and clinical staff. While we attempt to redirect the patient to the appropriate contact in secondary care, we often see further contacts generated as a result.
‘Doctor the secretary told me I’d be seen sooner if you write a new letter.’
‘I’ll be seen sooner if you upgrade me to urgent.’
These conversations lead to the dilemma of either going with the easy option of just writing the letter, which we know will have little or no impact, or having the difficult discussion with the patient about why their urgent problem is unfortunately no more urgent than that of the hundreds of other urgent cases stuck on lengthy waiting lists.
Today alone I have spoken to at least 10 patients and undertaken joint injections on two patients who are on a waiting list for specialist assessment or management. We are seeing these patients frequently and, in the absence of a suitably timed intervention, having to prescribe more potent analgesia to allow them to manage the pain associated with the conditions for which they are awaiting assessment.
There has been an inevitable increase in the use of private services. I am doing more private referrals and receiving more correspondence from private clinics than I have ever done before.
There is a fear that we already have a two-tiered system of those who can afford to access private care through self-funding and insurance and those who cannot. In reality we are also seeing those who cannot truly afford private healthcare borrowing money to try to speed up their referral process by accessing private investigations or assessments.
I regularly speak to patients whose families ‘club together’ to get them at least one private assessment and access to the care and treatment that they need. In Northern Ireland we are unique in the UK in having a border with a country of the EU.
This is only 10 miles from my practice in Armagh and, with cross-border schemes for patients already on surgical waiting lists, we are frequently left to deal with post-operative issues such as ‘urgent’ discharge medication and organising post-operative rehabilitation and care packages on their return to home.
The increased use of private services has had negative effects on our relationships with patients and lead to new interface issues. For example, with children waiting several years for ADHD assessments, parents are seeking private opinions and this is creating difficulty over the prescribing and monitoring of amber list medications.
We see this with delays to access to management for other disease modifying treatments across a number of specialties. It is a highly emotive and difficult area to manage and GPs are seen as the barrier to the patient receiving medication if we refuse to prescribe without the proper secondary care follow up. This increases stress and often leads to complaints within practices.
We desperately need radical reform to our elective care services. We cannot simply keep doing the same thing and adding patients to endless waiting lists. Staff in primary and secondary care are working tirelessly to manage patients as safely and efficiently as we can.
Until proper action is taken our patients will suffer on lengthening waiting lists and the effects will continue to have a detrimental effect to staff and services across primary and secondary care.
Conor Moore is a GP and a member of the BMA Northern Ireland GPs committee