Welcome to October’s blog. This month, I wanted to dive into the data and share updates on our performance in three key areas: primary care, elective care, and urgent and emergency care.

Primary care

General practice has significantly increased the number of appointments it offers over the past few years. In August alone there were 556,870 appointments. Here’s a quick breakdown of the data:

• 34.9% of appointments were with GPs.
• 75.9% were face-to-face and 16.7% by phone (a small number of home visits and video calls continue to take place).
• 53.8% of appointments occurred on the same day or the next day, which amounts to nearly 300,000 appointments.
• 18,067 people did not attend their appointment, which is a slight drop to around 3.5% of appointments.

For me, what stands out is the sheer volume of urgent and emergency care delivered in primary care. It’s estimated that 80% of all urgent and emergency care is provided by primary care, so it’s vital that we recognise and support primary care to maintain this.

On the GP Alert State (GPAS), about 45% of practices are submitting data, which is also helping us to better understand the pressures on general practice.

I welcome the renewed national focus on the interface between primary and secondary care so I’m very proud to share some of the progress we are making in this area. We now have an executive lead and an operational lead at each provider trust. Each trust is working much more closely with primary care and the ICB to respond to local issues as raised through the PID inbox, and they are also proactively, completing their gap analysis and action plans against the four national interface pillars.

We have held system wide monthly interface meetings for almost three years now, and so it is timely to review how these are working. Thank you to all who attended the recent interface workshop – in response we are revising our interface arrangements, with a view to monthly local meetings to improve local relationships and address local issues quickly, as well as a quarterly system level one to tackle system wide and contractual issues.

Elective care

The Government is aiming to get RTT (Referral to Treatment) back to 18 weeks within five years, which is a big ask and will require real transformational change to achieve. This is our current position:

• As of 22 September, our total waiting list was 144,533 patients.
• The system is working incredibly hard to tackle long waits and over the last month the number of people waiting over 65 weeks decreased significantly, from 2,766 patients to 1,955.
• No-one is waiting over two years, but 277 patients have been waiting over 78 weeks.
• Overall, about 1 in 7 of our population are on a waiting list for treatment of some kind.

So, there is much to do, and we clearly need radical transformation if we are really going to get on top of this.  Orthopaedics is one of the specialties with the highest number of patients waiting. The opening of the Norfolk and Norwich Orthopaedic Centre (NaNOC) will expand operations to 2,500 cases a year, and the new orthopaedic theatres at James Paget Hospital will soon add 1,400 theatre sessions annually.

Another specialty with very large numbers of people waiting is Gynaecology. We are working on multiple women’s health initiatives, such as improving women’s health literacy in our population, upskilling our workforce, particularly in primary care, expanding access to Long-acting Reversible Contraception (LARC), and improving access to menopause care.

We are also developing new pathways for Dermatology, and we have already put in place new pathways for Musculoskeletal services (MSK). This new self-referral and single point of access for MSK should help people help themselves and if necessary to get seen earlier, before their care becomes more complex. This in time should also help with demand for orthopaedic surgery. Have a look at the new MSK resources here.

On the diagnostics front, the opening of Community Diagnostic Centres at the Queen Elizabeth and James Paget Hospitals will also help ease the pressure on CT scan waiting lists, which remain the most pressing concern. A diagnostic centre at the Norfolk and Norwich Hospital is due to open early in the new year with five MRIs, four CT scanners, two X-Rays and two ultrasound rooms.

There is still lots to do, but I hope this demonstrates that we are making progress, and we are pulling together five year plans and trajectories so it’s clear what we need to do, when and how, to get elective care back to where we all want it to be.

Urgent and emergency care

Our urgent and emergency care performance has improved significantly over the last year. However, there has been pressure on the system over the past weeks, including an uptick in ambulance handover delays.

It’s important to remember that as a system we took the decision a year ago to focus everything we had on reducing handover delays. We did that to improve the speed that ambulances can get to the most urgent category 1 and 2 call outs, as this was the highest area of risk for our patients.

In recognition of the more challenging times over the past weeks, we have stood up our clinical risk panel again to maintain focus on this and how we can best balance the risk to people in our communities. For example, we know that community visits can sometimes get deferred so that the same team can support someone to be discharged from hospital. But if we keep doing this, the person at home may deteriorate so it’s very important to keep reviewing the impact of our decisions and to balance these risks as best we can.

Looking ahead to this winter, additional funding is unlikely, so we need to maximise use of our existing resources.

We’ll continue to work with our acute Trusts and ambulance provider to prioritise reducing ambulance handover delays so they can get back on the road as quickly as possible.

Our Unscheduled Care Coordination Hub is doing brilliant work to provide effective alternatives to a 999 call or a conveyance to hospital. Our virtual wards and community teams are also doing more and more to provide the right care to people in their own homes to prevent hospital admissions. Health and social care staff are also working together every day to support people with more complex needs to be discharged from hospital as soon as they are well enough to go home. And as I said at the start of the blog, our GP teams are supporting around 10,000 people with an on the day or next day appointment every single day.  

As always, there’s a lot happening across the system – let’s keep pushing forward together. And as ever, I welcome any feedback or questions.

Best wishes, Frankie