Intended for healthcare professionals

Opinion Talking Point

John Launer: When outpatient appointments are put on hold

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2479 (Published 19 October 2022) Cite this as: BMJ 2022;379:o2479
  1. John Launer, GP educator and writer
  1. London
  1. johnlauner{at}aol.com
    Follow John on Twitter @johnlauner

I have a long term medical condition that requires regular hospital review. In theory this should happen every six months. Nowadays, most of the appointment letters or texts I receive from the hospital tell me that my next review has been postponed, usually for a further six months. A series of such delays, beginning before the covid-19 pandemic but extending into it, led at one point to a gap of nearly three years without a face-to-face or phone appointment.

Because I’m a doctor and my condition is fairly stable, I can more or less cope with the resulting anxiety. I can access my GP fairly easily when I need to, and not only because I’m a colleague. I also know from the inside how much pressure the NHS is under and how threadbare its fabric has become: it was bad before the pandemic and is dangerously so now. All the same, I’m concerned about the risks to other patients in the same position who may not have any of the advantages I have, nor be in a position to monitor themselves. My own wait ended when I contacted the consultant directly, but I have no idea how long it might have lasted for someone not bold enough to do so.

During my wait I saw no sign that the hospital was taking any precautions when putting routine care on hold in this way. I inquired whether arrangements were in place for a clinician to screen everyone’s notes for risks before a manager cancelled a clinic because of service pressures or covid-19. The answer was no. Everything is evidently done by managers and administrators only. I also asked if there was a limit on how many times an appointment could be postponed or if there was a system for monitoring the consequences. I was thinking not just of heightened anxiety among patients but about adverse outcomes—medical complications, emergency admissions, or even preventable deaths among patients who should have been seen regularly. Apparently, this wasn’t the case either.

This is clearly unsafe practice, but repeated delays are still happening, and this may be the case in some other hospitals too. We already know about the frightening scale of delayed referrals, cancelled operations, and lengthening waiting lists in the NHS, but at least these are being measured. If routine outpatient care in some hospitals is also unravelling, it may be doing so invisibly and with no publicity.

Some simple measures could mitigate the likely harms and save lives. These could include phone reviews after a maximum interval or arranging for routine investigations to take place and be reviewed, even without an appointment, when safe to do so. If hospitals are having to reduce regular care for long term conditions, they should monitor this, prioritise any patients at risk, and have safety nets in place.

Footnotes

  • Competing interests: None.

  • Provenance and peer review: Commissioned; not externally peer reviewed.