NHS is to test scrapping the four hour A&E targetBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1148 (Published 12 March 2019) Cite this as: BMJ 2019;364:l1148
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As doctors practising in both primary and secondary care, we have seen the pernicious effect of targets that result in clinical priorities being overridden by management priorities, and result in stretched resources being directed to those with less clinical need. The pressure put onto doctors to admit patients, possibly unnecessarily, to avoid breaking 4-hour targets is certainly a notable example but the same effect is evident with all the targets. For instance, 2ww cancer targets have made it near impossible to expedite those patients with very high clinical suspicion of cancer, who need to be seen urgently in the next available clinic, over those with lower suspicion of cancer but who have red flag features and are nearing the 2-week deadline.
As with A&E targets, the most appropriate way to reduce this dysfunctional effect, whilst still providing meaningful measurable outcomes to hold providers and commissioners to account, would be to move to an average or mean waiting time target.
Similarly with the 18 week waiting target for elective care an average waiting time would allow providers to reduce the number of elective operations that require inpatient admissions in the winter period by expediting or delaying cases by a few weeks, for instance performing more day case procedures between January and March, and less hip replacements. This would help avoid the wholesale cancellation of operations that occurred last winter.
Changes away from such simplistic NHS targets are to be welcomed.
Competing interests: No competing interests