Daily Insight: Beyond the waiting list

Too much emphasis on prioritising waiting lists by factors such as deprivation risks missing the “real problem” of tackling inequalities in accessing care, a trust chief executive has said.

Pippa Nightingale said the conversation must shift more towards redesigning services to meet population need.

She told HSJ there are no tools to manage waiting lists and prioritise “the right people” and those that do could become “a bit of a tick-box” exercise.

Ms Nightingale said: “What we need to do is redesign the service so that people can access the service and the way that they need to access the service.

“It needs to be much more dynamic than just a tool that monitors the waiting list.”

It comes as LNWUHT claims to have become the first in the country to develop a “compound equity index”.

The monitoring tool aims to ensure care quality is consistent, regardless of factors such as gender, ethnicity, disability and socioeconomic status.

The index aggregates care variation across 30 indicators, such as access, effectiveness, and safety, and mathematically quantifies between groups — with a value of 0 indicating more equity, and 1 highlighting inequity.

LNWUHT provides services for more than 1 million people in north west London.

Showing their age

NHS England has found that one in five GP surgeries — and more than two-fifths in London — were built more than 75 years ago and is concerned a lack of space will stop it from meeting targets to train more GPs, HSJ has learned. 

An internal NHSE document seen by HSJ reveals details of a major audit it commissioned in 2019 of 8,900 GP buildings but has not made public, despite concern about the issue and a lack of robust information.

HSJ understands officials are concerned poor estates and lack of space will restrict the big expansion of GP training planned under the NHS long-term workforce plan. 

The NHSE slides, which include the figure, warn the “limited [GP] estate” means there is “strain on existing capacity and meeting current training needs is challenging”.

These practices are likely to be in converted houses, normally owned by GP partners, with very limited space and little scope for expansion.

Primary care sources told HSJ that they were having to turn away additional GP trainees and staff as buildings were full.

Royal College of GPs chair Kamila Hawthorne told HSJ that the “poor infrastructure” across general practice also has a “serious knock-on effect on the delivery of care”.