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TACKLING THE BACKLOG How SAS doctors can help to reduce elective surgery waiting lists
Tackling the backlog
Lasitha B Samarakoon examines how SAS and locally employed doctors can help to reduce substantial waiting lists for elective surgery in the UK
There are an estimated six million people waiting for elective surgery in the NHS1 . This represents one in 10 of the population, a figure that has increased by one third since the start of the pandemic due to the widespread disruption of NHS services.
The government has pledged to tackle this backlog with some £8bn in funding to the NHS within the next three years, boosting elective surgical capacity by 30% by 20242 .
SAS (covering specialty doctors and associate specialists) and locally employed doctors (LEDs, covering a wide range of posts, including Fellows and Trust-grade doctors) are an integral part of the NHS, comprising one third of the medical workforce. There are several ways they can help tackle the backlog.
WORKING AUTONOMOUSLY Most senior SAS surgeons are experienced practitioners who work independently with minimal or no supervision. Many have completed a structured training programme and hold specialist accreditation outside the UK. Some Trusts have a policy to officially recognise autonomous working by SAS doctors. Enabling and encouraging SAS surgeons with the right level of competence to work autonomously brings many benefits to SAS doctors, patients and Trusts.
This means SAS surgeons can undertake theatre and endoscopy lists to help deal with the backlog of cases. The available infrastructure may limit the number of extra lists available to SAS doctors at present, but exploring additional locations such as treatment centres could increase capacity.
LEADING TRIAGE CLINICS In many Trusts there is a bottleneck in initial outpatient appointments following GP referral to surgical services. Experienced SAS surgeons could run triage clinics to assess patients’ complaints and prioritise waiting lists accordingly.
The pandemic has seen the advent of telephone clinics that can be run without needing outpatient clinic space and support staff. The often-extensive experience of SAS surgeons can be very useful in a telephone setting where the doctor does not have the opportunity to physically examine patients before reaching a diagnosis, management plan and prioritisation.
WORKFORCE TRAINING The pandemic has reduced the exposure of surgical trainees to appropriate surgical training cases, with potential impacts on the length and quality of current surgical training. SAS doctors are often overlooked as a training resource. Many SAS doctors make ideal trainers and mentors, often having experience in different clinical settings. Some have been trained as trainers and are members of the Faculty of Surgical Trainers.
As such, SAS doctors should be given the opportunity to share their experience, and participate in the training and mentoring of trainees. This will help to upskill the surgical workforce, making more trained surgeons available to help deal with the backlog in elective cases.
SURGICAL OUTREACH Establishing and maintaining surgical outreach services is one important way of tackling the backlog. SAS surgeons are ideally suited to this role, because they have sufficient breadth of knowledge and experience to successfully lead and run such initiatives.
SAS surgeons and dentists can play a vital part in reducing the NHS waiting lists for elective treatment. Senior surgeons and managers should seek to allow the SAS workforce to practise to their full potential. This will enable autonomous working where appropriate, and facilitate SAS surgeons to act as trainers, mentors and leaders in establishing and running services where they are competent to do so.
Lasitha B Samarakoon Consultant in General and Emergency Surgery, University Hospitals of Leicester NHS Trust
References
1. www.bma.org.uk/ advice-and-support/ nhs-delivery-andworkforce/pressures/ nhs-backlog-dataanalysis [Accessed online 25.02.2022] 2. www.england.nhs. uk/coronavirus/ wp-content/uploads/ sites/52/2022/02/ C1466-delivery-planfor-tackling-the-covid19-backlog-of-electivecare.pdf [Accessed online 25.02.2022]
