Clinical Audit2

Waiting lists

A further parameter by which a surgeon’s expertise is judged is waiting lists. Dr Foster publishes my waiting times for outpatients as 56 days (8 weeks) and for routine surgery as 182 days (26 weeks). This data is produced by the North Bristol NHS trust but I have not been able to establish the process by which these figures are arrived at. I present my own figures on inpatient waiting times here.

 Out patient waiting times

Wiith regard to outpatient waiting times, the government only recognises GP referral outpatient activity as this is the only activity that they apply targets to. The majority of my outpatient activity in the NHS is tertiary referral work from other hospital doctors, activity that officially I do not do. This actually amounts to 86% of my NHS new patient work.

My NHS job plan includes two general out patient clinics a month on a monday. I attend one epilepsy multidiscplinary team meeting a month and three informal oncology MDT meetings a month. I no longer have a formal commitment to the Pain surgery MDT as this role has been taken on by my new colleague, Nik Patel.

In the private sector, the majority of patients I see come from GP referrals (87%).  Last year, I had one clinic a week at the BMI Bath Clinic and one session a week seeing  patients as part of the SWIS 'one stop' service, initially at the Bath Clinic and laterly at Frenchay. (See the section on SWIS activity for more details)

In patient waiting times

Waiting times for inpatient care reflect the resources that are made available to me. Where clinically appropriate I will try to treat a tumour patient as soon as possible. These along with the urgent cases that I receive while on call fill the ‘routine’ operating time that is made available to me. The general neurosurgical and pain surgery patients have no ring fenced resources for treatment except when they have been waiting for 6 months when they attract waiting list initiative funding. I have dedicated lists for epilepsy surgery cases but no ring fenced beds which results in a high cancellation rate for these patients also. (I probably need to make clear what I mean by a lack of ring fenced beds. The neurosurgical compliment of beds serves our emergency, urgent and routine activity. The beds may also be occupied by overflow cases from other wards, the accident and emergency department - ‘trolley wait’ targets are met by filling regional neurosurgical service beds - by patients waiting to return to their referring hospitals after treatment and patients waiting for rehabilitation. Even without these other pressures we do not have enough beds for elective neurosurgery).

Interpretation of inpatient waiting figures needs to take these factors into account. I present the waiting time in the last year (April 2005 to March 2006) for routine and urgent cases. I also present the percentage of cases that had their admissions cancelled at least once.

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