Written evidence submitted by Guy’s and St Thomas’s NHS Trust (NWT0039)

Shereen Hussain and Tyler Purvor

Acknowledgements: Adam Shaw, Francesca Forzano, Dragana Josifova, Eleanor Davies, Martin Kariuki and Balathas Thirugnanabalan

We write this brief on behalf of the Clinical Genetics service at Guy’s and St Thomas’s NHS Trust. Our service provides care for people and families with a range of genetic conditions. Our department falls under the branch of Specialist Ambulatory Services, an outpatient department that provides specialised care in a timely manner.

Background

NHS waiting times for elective care have been increasing in recent years.

Increasing wait times are an urgent challenge affecting patient health, staff wellbeing and system sustainability. Prolonged delays for treatment can worsen patient outcomes, increase patient stress, and can also increase the burden on other services that are used intermediately (1).

We have been dedicated to improving patient pathways and operational efficiency within our department.

The below table shows our average waiting times for our 2 main types of clinics, comparing June 2024 and July 2025. It shows how our wait times have reduced. This is also illustrated in Figure 1 below.

Our new average RTT time is 33.5 weeks. This means that on average patients are waiting for 33.5 weeks for their first appointment, from the date they were referred. Although this is still above the NHS 18-week target, our RTT has almost halved in the past year as a result of our prolonged efforts.

While the 18-week RTT target is a long-standing guideline, the Elective Recovery Plan is a new NHS policy which has been updated in 2025 (5). It aims to eliminate 52-week waits for elective treatment – to reduce this figure to less than 1% by March 2026. This aligns with the UK Government’s 10-year health Plan, ‘Fit for the Future’ (6). We have been adhering closely with these guidelines and very few of our patients are now waiting over 52 weeks.

Aims

This brief outlines the sustainable strategies that we have used within our NHS department to reduce waiting times. These strategies were informed by frontline experience, clinical expertise and proven best practices within our department. We have approached this issue from 2 perspectives – a clinical side and an administrative/managerial side.

Key recommendations are provided – this practical guidance can be translated to other similar outpatient departments within NHS trusts across the UK, to reduce their waiting times. 

Clinical strategies

The approaches we have used from a clinical perspective are as follows:

1. Extra clinics

Our clinicians have been running additional clinics, including evening and weekend services. This is in line with the Health Secretary’s plans to increase appointment capacity to address NHS waiting lists (7). These have been popular with our patients who are unavailable during the week (Monday-Friday 9am-5pm), for example due to work and/or childcare commitments.

2. Effective triage protocol and tightened referral criteria

In the NHS, triage is the process of assessing and prioritising patients based on the urgency of their need for care, and their suitability to be seen by our service. We have created a strict and effective protocol for triage, to ensure that our service is only seeing patients who need an appointment, and patients who we can help effectively through our services.

We have tightened our referral criteria by increasing our clinical threshold. We have also implemented an electronic version of the NHS referral form (e-Referral Service, eRS), which streamlines the process administratively and reduces our referral upload time. This can be pertinent when we are receiving an average of 200 referrals per week.

We have also ensured we are strict about geographic criteria. Our catchment area for patients includes many areas of South East & South West London, Kent and Sussex. Patients in areas outside of these will be seen by other Genetics departments in London. We ensure that we do not triage out of area referrals for our non-specialist clinics, to avoid our waiting list times increasing unnecessarily.

3. Clinical streamlining

We have streamlined the processes within our department – this has improved efficiency, optimised our staff’s time, and ultimately helped to reduce our waitlists. The strategies we have used include:

• Supportive clinical roles:

Introducing a ‘Genetics Associate’ (GA) clinic, to support the Genetic Consultants. Within this GA clinic, the patients had their genetic testing done before they saw the consultant. This allowed the consultant to obtain a complete picture at the time of consultation. This ultimately meant the majority of patients only had to be seen once by the consultant, not 2+ times, thus optimising our consultants’ availabilities and allowing them to see more patients.

• Prior information gathering:

Sending a clinical questionnaire prior to the patients’ appointments. This provided insight into their pertinent clinical information, and facilitated information gathering. This strategy worked to shorten appointment times, allowing our clinicians to see more patients per day. Additionally, we were able to screen and identify patients who did not require a formal appointment and could instead receive advice by letter.

• Multidisciplinary working:

Introducing Multidisciplinary Meetings (MDMs). These MDMs were arranged for complex cases and were scheduled before appointments. They were used to advise on investigations required, and streamline the process by minimising duplication of work by different clinicians and/or teams involved in the patient’s care.

• Waitlist validation:

Checking referrals to ensure the patient pathways are appropriate. For example, they will be moved to a different department if appropriate, finding results from other hospitals if tests have already been completed, or removed from the waitlist if already seen.

• Novel approaches to care delivery and patient contact:

Implementing new approaches to minimise the number of in-person appointments each patient had, hence optimising time for our clinicians. These included:

• Group sessions – where the consultation & information delivery was carried out in a group setting but testing was done individually. This allowed twice as many patients to be seen in a day, compared to a standard clinic where 1 patient is seen per appointment. A group clinic would allow 10 patients to be seen per day, compared to the standard 5 patients per day.
• Digital family history collection – sending out our information gathering questionnaires via a text message with a secure and personalised URL. This tool includes patient information on family pedigrees, which helps to run the clinics more smoothly and saves time.
• Sending advice by letter.

4. Clear communication

We noticed the importance of clear and effective communication, both within our department, to other departments in our trust, to external hospitals and GPs, and patients.

We receive referrals from GPs and hospital departments. We sent these departments digital tools to make them aware of our referral criteria and access policy, and support them with advice and guidance for frequently asked questions. This reduces our administrative workload through reducing the number of queries and peripheral / inappropriate referrals we receive.

Administrative strategies

The approaches we have used from an administrative perspective are as follows:

1. Patient Tracking List (PTL)

We implemented a Patient Tracking List (PTL) to monitor how long each patient has been waiting for, and ensure they are booked in order. We have ensured standardised utilisation of the PTL by administrative staff across our department. Staff are instructed to book patients in order of the number of weeks the patient has been waiting for, filtering by the clinical subgroup and staff member the patient has been triaged to see.

2. Optimised booking procedure

We have noted the importance of clear communication with our patients, to ensure they all attend their appointments where possible. Our current DNA (‘Did Not Attend’) rate is less than 5%, and we aim to maintain this.

It is important to maintain a low DNA rate, for several reasons:

• Efficient use of clinician’s time – preventing wasted appointment slots and allowing for better utilisation of resources
• Preventing disruptions – missed appointments can delay care for other patients
• Cost savings – missed appointments translate to significant financial losses for the NHS. For example, 1 missed appointment in Clinical Genetics costs the department £300. By reducing outpatient appointment DNAs to 2%, the NHS could save £266 million per year across the UK (8).

We ensure we call our patients prior to booking. We contact our patients three times via phone call, leaving a voice message each time with a phone number for them to call us back on. On the 3rd attempt, we will manually send them a ‘validation letter’ which allows them to contact us within 14 days by phone or email, or they will be discharged from our service. This ensures that we remove all patients who do not engage with our service from the waiting list, which reduces our wait times overall.

Additionally, we aim to give our patients 6 weeks’ notice of their appointment, and we will leave instructions to contact us if they are unable to attend the provided date. The only time we will book under 6 weeks is if we have spoken to the patient on the phone/via email and received direct confirmation.

We also encourage our patients to sign up for MyChart, a patient portal system. This system provides patients with electronic reminders about their appointments, reinforcing their attendance. It also reduces administrative time, by allowing patients to access their own clinic letters and results directly, quickly and efficiently.

3. Administrative behavioural change

Our administrative team are at the core of our mission to reduce our waiting list times. We note the importance of reinforcing our goals and objectives amongst the whole team, so they are all aware of our operating procedures, and adhere to these. We ensure we built rapport and communications between the administrative and clinical teams to achieve our shared departmental goals.

We schedule regular meetings with our administrative team and clinical subgroup leads (for example our lead Genetic Counsellors), to coordinate administrative work with our clinical priorities.

Potential developments

Digital communications and the use of Artificial Intelligence (AI) in healthcare are rapidly evolving fields, and are becoming increasingly more applied within health services.

Some developments we are beginning to implement in our department include self-scheduling options for patients to book their appointments via a secure website, and providing informational videos for patients online.

The use of AI to facilitate access to elective care departments is another possibility for the future, for example use of a chatbot to answer patients’ Frequently Asked Questions and sending out communications to patients.

Key recommendations

References

1. Salisbury et al (2023). A waiting crisis? Lancet. 2023 Feb; 204(10375):428-429.
2. James et al (2024). The cost of keeping patients waiting: retrospective treatment-control study of additional healthcare utilisation for UK patients awaiting elective treatment. BMC Health Services Research, 24, 556.
3. NHS England (2025). Statistical Press Notice: NHS referral to treatment (RTT) waiting times data. Retrieved from URL [Feb25-RTT-SPN-Publication-PDF-386K-76538.pdf]. Accessed 11 Aug 2025.
4. NHS England (2025). Referral to treatment. Retrieved from URL [https://www.england.nhs.uk/rtt/]. Accessed 10 Aug 2025.
5. NHS England (2025). 2025/26 priorities and operational planning guidance. Retrieved from URL [https://www.england.nhs.uk/long-read/2025-26-priorities-and-operational-planning-guidance/#:~:text=Our%20national%20priorities%20for%202025/26,-The%20national%20priorities&text=improve%20A&E%20waiting%20times%20and,30%20minutes%20across%202025/26]. Accessed 22 Aug 2025.
6. Department of Health and Social Care (2025). Fit for the future: 10 Year Health Plan for England – executive summary. Retrieved from URL [https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future/fit-for-the-future-10-year-health-plan-for-england-executive-summary]. Accessed 22 Aug 2025.
7. Department of Health and Social Care and The Rt Hon Wes Streeting MP (2025). Fit for the Future: Health and Social Care Secretary’s Oral Statement to Parliament. Retrieved from URL [https://www.gov.uk/government/speeches/fit-for-the-future-health-and-social-care-secretarys-statement]. Accessed 11 Aug 2025.
8. NHS England (2023). Reducing did not attends (DNAs) in outpatient services. Retrieved from URL [https://www.england.nhs.uk/long-read/reducing-did-not-attends-dnas-in-outpatient-services/]. Accessed 11 Aug 2025.