Lesley Hill On primary care

Published: 05/02/2004, Volume II4, No. 5891 Page 31

A lot of primary care trusts are interested in managing waiting lists, but not many are doing it. It is quite a simple process, which has a tendency to be made more complex than it needs to be. All the primary care trusts in Bradford are unusual in that we 'own' our waiting lists. The arrangement with our main acute provider, Bradford Teaching Hospitals trust, is simple.

The hospital agrees to deliver an amount of activity and we manage the waiting list. If the waiting list size goes up and waiting times get longer, it is the PCT's problem if the hospital has delivered the activity we have commissioned. If the hospital has not delivered the activity commissioned, the PCT pulls funding and buys activity elsewhere.

Each year the PCT goes through a rigorous modelling exercise to determine what activity needs to be commissioned in secondary care.

The hospital also looks at activity requirements at PCT level. Because we have been doing this for a few years, the exercises generally produce similar results, and agreement is reached about what the hospital will deliver.

But when the PCT first started analysing activity requirements, the hospital modelling always showed greater activity needs than the PCTs did, which led to some interesting - and heated - debates. These were usually resolved by the PCT taking the risk as to whether waiting-list targets were achieved. To some extent the hospital was right. If we had commissioned the extra activity, we would at worst have had an even smaller waiting list and shorter waiting times.

Bradford Teaching Hospitals trust has a policy to deliver activity by PCT. This means there can be different waiting times for each PCT. If a PCT in Bradford does something new which brings waiting times down, the other PCTs copy it. There is a constant 'racking up' of services and everyone wins - including the hospital, which would otherwise struggle to meet waiting-time targets.

North Bradford PCT has taken waiting-list management further, devolving secondary care activity and budgets to individual practices.

In addition, we provide practices with the details of their patients on the waiting list. After all, the GPs and nurse practitioners who refer patients are actually determining the size of the waiting list. The PCT ensures that practices are referring the right patients to secondary care by using quality markers.

North Bradford PCT also believes in a plurality of providers.Along with our main acute provider, we have services at Airedale Hospital and Leeds Teaching Hospitals trust.We also have a wide range of locality services and a three-year contract with the local private hospital and are completing negotiations for an independent treatment centre.

Our plan for the future is to have maximum waiting times of four weeks for inpatient and day-case treatment, and two weeks for outpatients and diagnostics.When we get to this point we will no longer need two streams of patients, urgent and routine, because all patients will be treated as if they were urgent. Plans are in place to clear the waiting list for inpatient and day case treatments and diagnostics.

Lesley Hill is deputy chief executive of North Bradford PCT, winner of the Prime Minister's Award at last year's HSJ Awards.