Cardiologist shortage prompts NHS trust to ask GPs to cut referrals

BMJ 2016; 352 doi: (Published 03 March 2016) Cite this as: BMJ 2016;352:i1304
  1. Ingrid Torjesen
  1. London

A prestigious teaching hospital has asked GPs in neighbouring clinical commissioning groups (CCGs) to send their cardiology patients elsewhere, as a severe shortage of consultants means that it cannot guarantee the safety of its services.

Addenbrooke’s Hospital, part of Cambridge University Hospitals NHS Foundation Trust, has only just over half the consultant cardiology workforce it needs. Just 3.5 whole time equivalent (WTE) cardiology consultants are in post at the hospital, and the trust said that its attempt to recruit a further three WTE doctors had been unsuccessful and that it has been unable to find locums to cover the posts temporarily.

Evelyn Barker, chief operating officer at Cambridge University Hospitals, and Tracy Dowling, chief operating officer at the local Cambridgeshire and Peterborough CCG, have written to neighbouring CCGs asking them to instruct GPs to send all routine cardiology patients elsewhere.

Their letter, dated 25 February, said that the waiting time for a routine cardiology appointment at Cambridge University Hospitals was currently 22 weeks and that the list was growing by 50 patients a week. “This clearly represents a potential clinical risk for patients who may have significant cardiac disease that cannot be ignored,” they wrote.

The trust is experiencing “unprecedented levels of demand for outpatient services,” the letter said, driven largely by demand for the rapid access chest pain pathway, which has a maximum two week wait, and demand was 52% higher in the first three quarters of 2015-16 (April to December) than at the same time the previous year.

The letter explained, “As these patients are necessarily prioritised in order to achieve this target, the waiting list for routine cardiology outpatients is rising by 50 patients per week, and is currently at 22 weeks.

“It is with regret that we write to inform you that CUH [Cambridge University Hospitals] finds itself unable to continue to safely provide the current level of access to its cardiology outpatient services.”

The trust is trying to mitigate the effects of the shortage by changing the working pattern of a cardiology fellow, recruiting an agency locum, and working with the neighbouring Papworth specialist heart and lung hospital, to gain further cover for outpatients and to recruit to “more sustainable” joint cardiology consultant posts in the future.

Despite these interventions the trust expects the waiting list to continue to grow, so it “can only commit to see urgent referrals and cannot guarantee that this will bring the routine wait back to within safe levels at this time,” the letter said.

Bedfordshire CCG, one of those that received the letter, told The BMJ that it expected the restrictions to affect only a small number of patients, as only two patients per practice were referred to Cambridge University Hospitals’ cardiology services in 2015.

“CUH will still see urgent referrals, and Bedfordshire GPs will continue to refer patients to a variety of hospitals which provide outpatient cardiology services as is currently the case under the NHS rules of patient choice,” the CCG said in a statement. “Referrals can be handled on a case by case basis because of the small numbers involved and while the temporary closure is unusual, we are satisfied that this decision has been taken to preserve patient safety.”

Cambridge University Hospitals will review its restriction on routine cardiology referrals in three months. Routine cardiology patients in the Cambridgeshire and Peterborough CCG, where the trust is situated, continue to be referred to Cambridge University Hospitals, but the CCG said that routine cardiology patients were also being referred to other local hospitals, including Hinchingbrooke, Papworth, and Peterborough City, where the waiting lists and staffing “remain within usual levels.”

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