Rising wait lists & winter pressures – the catalyst to increased abuse of NHS staff

NHS waiting lists could top eight million by next summer, with chronic staff shortages and a lack of funding suggested to be the main drivers, according to new data from the Health Foundation Charity. With an already record number of people on the hospital waiting list, as the winter months draw closer, long waits for emergency care are a growing cause for concern.

With staff shortages and staff overworked, against a backdrop of an elective backlog which is rapidly growing by the day, the supply-demand challenge means the NHS is struggling to hire at the speed in which it needs to. It’s perhaps unsurprising, but disappointing, to see such a strong correlation between rising wait list times, and the abuse of NHS staff.

According to data from DrDoctor, three quarters (75%) of NHS hospital administrators (think hospital receptionists, ward clerks etc), cite rising waiting lists as one of the main causes of rising abuse towards them from patients at work. And perhaps most worrying of all, more than a third (35%) admitted they have considered leaving the NHS to escape the hostile working environment.

There’s no simple solution to these challenges. But, if we’re to protect staff and patients, we need to reduce the elective backlog and ensure that the infrastructure of the NHS is strong enough to withstand future pressures.

Whilst the list of challenges the NHS is grappling with feels ever-growing, we see two very clear challenges that we can start to tackle head on to support staff and patients, now.

Challenge One: The initial appointment management process 

The first of these challenges is patients’ frustrations with the appointment management process and its implications on NHS staff.

Traditionally, patients are sent a physical letter in the post, with a date, time and hospital listed for their appointment in the outpatients department. If the patient can’t attend, they might just not attend, leading to another appointment slot logged as ‘Did Not Attend’. But, they might also try to ring the hospital to change the appointment. They might have no luck getting through. Or, on their 7th attempt at calling, frustrated with the time and effort it’s taken, they might get through and then release that frustration on the person answering the phone. This lengthy process means that you might not be surprised to hear that data commissioned by DrDoctor revealed that abuse of NHS Hospital Administrators is more likely to come over the phone (48%), when compared to in person (28%).

To relieve some of this pressure on frontline NHS workers, and enable patients to manage their own appointment, we need to build a digi-physical hybrid healthcare system that puts the power of appointment management into the hands of the patient. Harnessing tools such as Patient Engagement Portals (PEPs) is one way we can do this. Using PEPs, patients gain direct access to the appointment diary, ensuring a smoother outpatient experience and a much improved dialogue with hospital staff.

For example, University Hospitals Birmingham (UHB) uses digital solutions to alert patients of new appointments, allowing them to reschedule or cancel where necessary on their phones. UHB sent 1,569,700 appointment notifications and reminders and 794,700 digital letter notifications to patients between the 1st January and 31st August, 2023.

This totalled to 72% of patients viewing their letter online, easing the patient experience by curating everything in one digital safe space, and cutting administrative tasks. Lessening the administrative to-do lists benefits the NHS sustainability agenda and frees up time for staff.

Challenge Two: The follow-up appointment management process

A second challenge can be found in association with the follow-up appointment management process. Understandably, the time between initially being seen by the Clinician and waiting for results, or your next appointment can be extremely stressful.

Whilst emotions are heightened and individuals are keen to be seen at their earliest convenience, managing follow-up appointments can put further strain on our NHS staff. Recent data commissioned by DrDcotor highlighted that other factors cited as contributing to the abuse of frontline NHS staff included being frustrated on behalf of a loved one (56%), not being able to easily rearrange an appointment (42%) and expecting patients to attend an appointment during the working day, or on multiple days to see varying specialists (33%).

One way we can work to relieve the pressure on our NHS staff and make the appointment management process run more smoothly for patients is through implementing Patient Initiated Follow-up (PIFU). Encouraging patients to join and embrace a Patient Initiated Follow-up (PIFU) pathway is an effective tool in facilitating hybrid healthcare. Essentially, PIFU ensures patients only book an appointment if – or when- they need it, rather than waiting for the Clinician’s green light.

For example, imagine I’m a patient who has struggled with a condition that has faded with age, it would make sense that my doctor continued to see me twice a year, to keep in check with my latest symptoms. However, if after these appointments all is well, it would be possible for me to be transferred onto the PIFU pathway.

But, what happens if these symptoms suddenly come back? On the PIFU pathway, I’d then be able to initiate a follow-up via the appointment booking tool. This means the waiting time that I’d been used to, waiting for my clinician to get back to me on next steps, is entirely diminished. In a recent report we commissioned with EDGE Health, PIFU’s effectiveness was illustrated, finding that increasing the number of patients using PIFU could lead to at least 1.18 fewer outpatient follow-ups per patient. And if rolled out on a national level, PIFU could create £167.2 million in savings, whilst avoiding 1.4m outpatient follow-up appointments.

Putting more patients on the PIFU pathway is an effective way to eliminate unnecessary appointments and DNAs, whilst ensuring patients are seen when they need to be.

Looking Forward

As we look to the future, it’s important to recognise that these are not quick-term solutions. As capacity challenges and other external factors continue to put pressure on our NHS and its workers, action needs to be taken.

Our NHS requires real investment into the digitisation of its infrastructure. And a great place to start is by digitising the appointment booking and management system, and encouraging trusts to implement PIFU’s. Ultimately, this will create a much more seamless pathway, ensuring the right patient is at the right place, at the right time, which in turn, will relieve the pressure frontline workers and NHS staff currently continue to face.

By Tom Whicher, CEO and Founder, DrDoctor


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