Cerner Corporation, News

A waiting list approach flipped on its head

waiting lists

This is a sponsored article.

Making the Patient Tracking List (PTL) available to general practice in North Central London (NCL) is proving to be an effective approach.

When thinking about how best to address the backlog of patients, it’s natural to only consider the locations where the patients will be treated, but Amy Bowen, director of system improvement for NCL, says her team saw the value of involving primary care in the conversation. “Initially, everyone considered the PTL from secondary care, but we thought ‘let’s flip it on its head’,” she says.

The approach uses funding from the NHS’s elective accelerator sites initiative to form multi-disciplinary Proactive Integrated Teams (PITs) that can access the PTL using the elective recovery dashboard in the Cerner population health platform, HealtheIntent®.

waiting list
Figure 1: Northern Central London (click to enlarge)

Like a Formula 1 pit crew supports a racing car driver, the objective for the PITs is to use data to optimise and maintain a person’s health while they await treatment. The need is very real across the NCL catchment area, with over 100,000 people having waited over a year for treatment and 300 waiting for more than two years.

The Patient Tracking List is a forward-looking management tool used by the NHS to monitor Referral to Treatment (RTT) and diagnostic waiting times for all patients across England. Even before the pandemic, demand for hospital treatment was outstripping capacity and, with the pressures on delivering care over the past two years, this has led to increased backlogs and longer waits. By April 2022 there were more than two million patients waiting over 18 weeks, with over six million in total waiting for treatment.1

The effort leverages the holistic and long-term nature of the primary care relationship to support people on the PTL. “GPs get the concept easily and they welcomed the fact we were making bandwidth for this,” Bowen says. “This stuff floats my boat because it’s giving people a data-driven, health-inequalities-focused rationale for working together.”

The elective recovery dashboard utilises integrated data from across the system – including primary care – to provide a rich system-to-person view of the elective waiting list. This assists primary care and community teams to prioritise cohorts and more effectively manage patients on the waiting list.

The idea was conceptualised by Katie Coleman, clinical lead for primary care, who says that delivering person-centred and coordinated care is the aspiration of everything she does as a GP.

For Coleman, the PITs are primarily aimed at improving the health of individuals on the waiting list so they can “wait well” and be ready for the procedure when their turn comes up.

“If we can get upstream with their care and identify the things that might prevent them from actually having their surgery, we could then potentially ensure that when they do hit the top of the waiting list that they are in the best space possible,” Coleman says.

The second key element is looking at the wider determinants of health and how a person’s condition impacts their day-to-day life – for example, a person waiting for a hip replacement who is unable to work due to pain.

“If we identify those critical cases that if they don’t have their procedure, they might be at risk of spiralling down that social ladder, we would look to try and help to escalate them and to reprioritise their position in the waiting list,” says Coleman.

The approach is expected to lead to a number of benefits – not only improved health outcomes for the population, but also cost savings for the NHS.

“If you can maximise people’s wellbeing in advance of their procedure, then we know from the research that they have a shorter inpatient stay,” Coleman says. “They have a shorter rehabilitation period, so they’re able to get back up and doing what they need to do quicker.”

Enabling people to get back to work sooner reduces the need for social care and sick leave, and can lead to increased productivity in the workforce.

“Also if we support people to lose weight, bring their blood pressure under control, support them to achieve improved diet, sugar control if they’re diabetic, and so on, all of this over time will also help to drive down the risk of complications,” says Coleman.

“And that obviously has cost savings for the inpatient stay, but also cost savings potentially for the system as a whole.”

NCL’s five boroughs have identified priority cohorts and are working to improve the experience for both patients and care professionals. For example, Haringey is stratifying patients with a diagnosis of severe mental illness combined with two or more long-term conditions.

waiting lists
Figure 2: NCL’s Proactive Integrated Teams Approach (click to enlarge)

Jalak Shukla, clinical pharmacist and director of operations for the Haringey GP Federation, says the rationale for this was to provide additional support to patients who are less likely to attend for their procedure when they get to the top of the list.

“It’s a proactive approach, but we’re managing a caseload of patients identified for surgery, making sure they make it, looking after them after the surgery in the communications that they should be receiving, plugging them into the right services, and then putting them back into the care of general practice,” Shukla says.

“All of it’s proactive, all of it’s taken care of and then they can go back to business as usual, accessing the system when they need it.”

An additional benefit of the PITs is the relationship building between primary and secondary care, especially given the fact that post-COVID recovery work is a high priority across the system.

“We know secondary care can’t do it on its own,” Shukla says. “Looking at that list jointly is showing how the system is going to work better together, with primary care picking up what it can to ensure that patients are optimised in the interim.”

The proactive population health management enabled by HealtheIntent is encouraging clinicians to think differently about caseload management.

“We can actually do a one-size-fits-all review for patients and that’s only possible because we’ve got this shared platform,” Shukla says. “The filtering of which long-term conditions they have, their clinical context, their background, their age, the number of contacts that they might have had with the system – all of that data allows you to get a high-level view of what’s going on in your own PCN [primary care network].”

Moving forward, Shukla expects this type of approach to be adopted beyond elective recovery, particularly because of the holistic nature of the approach.

“I think it can make a patient’s journey a lot less fragmented,” she says. “Let’s deal with the long-term condition issues. Let’s deal with the social care issues. Let’s sort out the issues they have with referrals with secondary care. And let’s do it all at once.”

As systems continue to explore ways to meet the demand of the backlog of patients awaiting elective treatment, innovators across the country are using data to help prioritise, optimise and reduce redundancy.

To learn more about how Cerner solutions can support your organisation please visit their population health management solution page.

1 Number of patients waiting over 18 and 52 weeks for consultant-led elective care and number of people on NHS waiting lists for consultant-led elective care | Source:

A person-centred, digital first approach to recovery

digital first

Ensuring that patient pathways are digitally enabled and person-centred is critical to tackling the elective backlog, writes Patricia Wynn, Director and Sales Leader, International Public Sector Health, Cerner Corporation

NHSE guidance states that “our ambition is to improve core digital and data services in hospitals to ensure we have the basics right.” A leading EPR provider in the UK and globally, Cerner supports systems to reach the minimum digital foundation and strive for HIMSS Stage 7 and beyond.

Cerner work across provider collaboratives to enable shared instances of the EPR. ICS-level collaboration reduces total cost of ownership and enables sharing of resources, such as PMO, training, back office and support. For example, a shared instance of Cerner accelerated provider collaboration across North West London ICS.

Imperial and ChelWest began sharing a domain in 2019 and now London North West and Hillingdon are set to join. According to Kevin Jarrold, ICS data and digital lead, “we have a growing agenda around collaboration across care pathways and the shared domain is absolutely fundamental.”

A shared domain has enabled NWL to gain efficiencies and generate much-needed capacity. Leaders can see across the system and transfer patients more effectively from one site to another. Virtual ward capacity is also managed centrally and embedded into the core EPR. Remote patient monitoring is leveraged from a variety of vendors, with all data feeding centrally into virtual wards created within the core EPR, enabling more efficient workflows and the sharing of virtual care staff.

Prioritising care

The national guidance outlines care must be prioritised based on clinical urgency, the impact of waiting on individuals and potential inequalities. To achieve this, North Central London (NCL) ICS uses Cerner HealtheIntent®, a data and analytics platform that provides a single longitudinal record for every citizen, comprising data from all health and care organisations across the ICS.

According to Amy Bowen, director of system improvement, “[We built] an elective waiting list dashboard in HealtheIntent. Now we can show GPs for the first time ever what their waiting list looks like. We can cut that data by all the demographic factors, e.g. how many people have long-term conditions and how many? We can look and see by ethnicity, by deprivation – we can combine several factors. And we can actually understand that population at a practice level, at primary care network (PCN) level; by specialty, by borough.”

Transforming care

NHS guidance outlines transformation should focus on flexibility, ease of access and citizen control. Re-envisioning patient pathways – and ensuring they are digitally enabled and person-centred – will be critical. Royal Free London (RFL) has standardised and digitised 40 pathways.

Cerner experts are involved from the beginning of pathway design. Dr John Connolly, CEO of the Royal Free Hospital and group director of clinical pathways shares, “The goal of this ambitious programme is to ensure every patient can get the same high-quality treatment in any of the Trust’s three hospitals… and to create value for the entire healthcare system in the locality – not just our hospitals, but also primary care and public health services in an area that has high levels of deprivation.”

Supporting patients

Ultimately, a person-centred, digital first approach must include the person at the centre. Cerner Patient Portal UK, delivered in collaboration with Induction Healthcare, enables interaction and engagement between caregivers and their populations. A prostate cancer survivor in the Wirral explained, “I cannot emphasise how much the patient portal has improved the quality of my life. Those two weeks of waiting – the stress of revisiting the room where I was given my diagnosis – all that is gone now.”

NHSE’s operating priorities will not be achieved by overworking caregivers and staff, but by enabling them to work smarter and more collaboratively. Contact Cerner Corporation if you share a belief in the power of technology-enabled transformation and want to discuss how Cerner can support your system as in tackling the unprecedented backlog of demand.