GPs will be offered financial incentives to discuss with specialists whether patients can be treated outside hospital, under radical plans to cut NHS waiting lists.
Doctors will be given £20 each time they consult a specialist either by phone or email under the so-called advice and guidance (A&G) scheme, to see if there is an alternative to hospital visits and treatment.
The plan is one of a series of reforms being announced on Monday by the prime minister, Keir Starmer, and the health secretary, Wes Streeting, who have promised to ensure that 92% of NHS patients wait no longer than 18 weeks for treatment.
Government officials said that too often GPs were arranging for patients to go to outpatient departments which caused avoidable pressure on hospitals. With MPs returning to Westminster, ministers will also unveil upgrades to the NHS app to enable patients to choose providers, book appointments in more settings and receive test results.
“If the wealthy can choose where and when they are treated, then working-class patients should be able to as well, and this government will give them that choice,” Streeting said.
“Our plan will reform the NHS, so patients are fully informed every step of the way through their care, they are given proper choice to go to a different provider for a shorter wait, and put in control of their own healthcare.”
Ministers say that paying GPs to use the A&G scheme routinely could mean 800,000 additional cases are treated in the community every year.
This could be by nurses in GP surgeries, in pharmacies or by physiotherapists. The £80m cost of paying GPs for doing so will be taken from existing hospital elective care budgets.
Streeting said on Saturday night that more care in the community was crucial to easing pressure on hospitals and cutting waiting times: “The root of the NHS waiting times crisis is 14 years of mismanagement of the NHS, which saw community services slashed and patients piled into hospital despite it not being the best place for them to be. Shifting care from hospital to the community is one of the three big shifts we will implement to reform the NHS.”
Conditions for which patients might be offered alternative treatment in the community include ear, nose and throat issues. About 50% of referrals to secondary care include simple age-related hearing loss, tinnitus, ear wax removal, simple ear infections and other related conditions – much of which can and should be safely and effectively managed in an out-of-hospital setting. Streeting also said that the changes to the NHS app would move the NHS “into the digital age” and also help cut waiting times.
Prof Phil Banfield, chair of the BMA council, said the proposals would have limited effects. “With 7.5 million people waiting for care, the app may help some patients navigate disjointed and complex pathways of care, but an upgrade to the NHS app on its own won’t make serious inroads into waiting lists without significant improvements to other parts of our healthcare system,” he said.
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Tim Gardner, assistant director of policy at the Health Foundation, said: “We welcome the NHS’s plan to tackle waiting times for routine hospital treatment. With a waiting list of 7.5m and nearly 235,000 waits of over a year, there are too many patients waiting in pain, many with their conditions worsening over time.
“But we should be under no illusions about just how stretching the targets are in this plan. Meeting the [waiting list] pledge would require improvements of a comparable scale to those achieved by the last Labour government in the 2000s, but in more difficult circumstances and with far lower levels of funding increases.”
