Publish date: 21 March 2023
Faster advice good for patients and the NHS
Northumbria Healthcare has slashed treatment waiting times for gastroenterology (GI) patients in a move that could be replicated in other parts of the NHS to help reduce the time people spend on waiting lists.
Hospital consultants in Northumberland and North Tyneside have reduced the waiting times for gastroenterology outpatients by offering rapid reviews of GP referrals, with senior specialist management advice and rapid access to clinic appointments.
Across the NHS, large waiting lists for hospital outpatient appointments have built up for patients referred to see hospital consultants and as a result they can sometimes wait weeks or months before seeing a doctor in hospital.
So far, the changes at Northumbria have led to a significant reduction in waiting times for routine GI outpatient appointments - down from 4 months to less than 4 weeks.
The team can also provide advice to GPs around the investigation and treatment of those patients who can be managed in primary care within 48-72 hours. At the same time, there has been a significant increase in the number of GP referrals into GI services.
The gastroenterology department at Northumbria treats a wide range of conditions relating to the liver and digestive tract (this is the gullet, stomach and bowel). This includes common problems such as ulcers, heartburn and change of bowel habit but also more complex conditions or long-term illnesses such as chronic liver disease and inflammatory bowel disease (IBD).
Consultants in Northumbria Healthcare have worked on delivering rapid specialist advice and treatment plans to patients, aiming to offer support to GPs to manage suitable patients in the community, but also freeing hospital clinic appointments to see patients much more quickly when needed.
This frontline senior review and referral triage also ensures that patients can also be referred directly to receive diagnostic tests such as endoscopy when needed, as well as ensuring that patients who require outpatient review are seen by the right clinical team first time.
Consultant gastroenterologist Dr Matt Warren explains: “Traditionally patients have waited for an appointment at a hospital outpatient department to get advice about their condition but we felt that consultants could offer a better and more rapid service by adapting this model and offering treatment and expert advice in a more flexible and individualised way.
“By moving to an advice and guidance model in selected and appropriate cases we were able to offer very quick advice to GPs within days, rather than patients having to wait weeks or even months for an outpatient appointment that would have resulted in the same tests or treatments.
“This has freed up some outpatient clinic capacity and now if a GP sees a patient that they are particularly concerned about we are able to offer very rapid outpatient review, far more responsive and flexible than under our previous system.”
To help improve the service the team has:
- Worked with GPs in shared learning events to discuss common GI conditions
- Championed an advice and guidance service to offer rapid specialist advice for GPs to support them in the care of patients who do not require urgent hospital appointments
- Ensured that primary care views are heard by delivering a survey of local GPs
- Worked to ensure that advice given to GPs is helpful and collaborative, for the benefit of the patients rather than an administrative or gatekeeper process.
Alistair Blair, executive medical director at Northumbria healthcare and a Northumberland GP, says: “Gastroenterology has really stood out as giving useful, bespoke advice to GPs that helps us manage patients much more efficiently and without the need to always join a hospital waiting list.
“When it works well it’s really enabling because as a GP or a patient you get an answer back very quickly, but that also means where patients do need to be seen they can do that much faster. The team are also very aware of the avoiding simply shunting work back to primary care colleagues”
It is hoped that some of the improvements delivered by Northumbria Gastroenterology and the lessons learned in the process may be replicated or adopted by other parts of the NHS as part of elective recovery and will help to speed up access to specialist advice and treatment, reduce waiting lists and ultimately improve the health of the population.
This project has been featured as a case study for the following:
NHS Providers monthly activity tracker - https://
NHS Digital - e-Referral Service - https://digital.nhs.uk/services/e-referral-service/case-studies/cutting-waiting-times-using-the-e-rs-advice-and-guidance-channel