Ambulance services

• Since June 2012, ambulance trusts have been given eight minutes to respond to the most urgent cases, and nationally no more than 25 per cent of these calls should be responded to outside this time.

• This standard was met until 2013/14 but for all subsequent years has been missed. In the most recent data, performance remains poor, with 32 per cent of calls in September 2016 being responded to after eight minutes. This is the worst-ever performance seen in September since this target was introduced.

Accident and emergency

• In quarter two 2016/17 the proportion of patients waiting more than four hours from arrival to discharge, admission or transfer in all A&E departments was 9.4 per cent (more than 558,000 patients in total). This is the highest proportion in the second quarter of the year since 2003/4.

• Pressures to admit more patients continued to impact performance against the four-hour standard in the second quarter of the year (Figure 30). Compared to the same quarter last year, A&E attendances were 5 per cent higher this year (Figure 31) and emergency hospital admissions from A&E increased by 4 per cent (Figure 32).
• These small percentages represent large numbers. The increase equates to more than 283,000 additional attendances and 40,400 additional admissions to hospital in the second quarter of 2016/17 compared to 2015/16.
• To put it another way, for each month so far in 2016/17 this is the equivalent of an additional 77,530 attendances at A&E departments and 13,835 admissions from A&E compared to the previous year.

• There has been an increase in the number of patients waiting more than four hours from decision to admit from A&E to admission to a hospital bed on a ward (‘trolley waits’): more than 107,600 patients in quarter two 2016/17, 44,344 patients (70 per cent) more than the same quarter 2015/16 (Figure 33).

• The proportion of patients waiting more than 18 weeks to begin their treatment increased to 9.4 per cent in September 2016 (Figure 34). This is the seventh month in a row that the target (8 per cent) has been breached, and is the worst performance since this target was introduced in April 2012. In total, there were more than 348,500 patients still waiting to begin their treatment after 18 weeks at the end of September 2016, and more than 1,181 of these patients have been waiting for more than a year.

• For the targets that were dropped last year, latest figures show that the proportion of admitted patients treated after having waited more than 18 weeks remained above 20 per cent in July, August and September 2016. The proportion of non-admitted patients waiting more than 18 weeks was more than 9 per cent in September 2016.

• The total elective waiting list continues to grow. In September 2016 the total waiting list increased to 3.7 million, an increase of more than 411,470 patients compared to January 2016.
• Furthermore, this total does not include several trusts that have not been reporting their waiting lists. Including these trusts, NHS England estimates that the true waiting list in September 2016 was more than 3.9 million patients (Figure 35). This puts the waiting list back to the highest level since December 2007.

• The proportion of patients waiting more than six weeks for a diagnostic test has now missed its target (1 per cent) for the past 34 months in a row.

• The overall waiting times target for cancer treatment is that no more than 15 per cent of patients should wait more than 62 days from an urgent referral from their GP to receiving treatment for their cancer. This target was met from quarter four 2008/9 until quarter four 2013/14, when it was missed (15.6 per cent). In the latest quarter (quarter two 2016/17 (July to September 2016)) performance was similar to the previous quarter, increasing fractionally to 17.7 per cent. This standard has not been met for the past two and a half years (Figure 36).

• At the end of September 2016, 6,775 patients were delayed in hospitals, the highest number ever published and an increase of 29 per cent since September 2015 (Figure 37).

• The number of total days delayed increased to more than 196,000 in September 2016, the highest ever recorded (Figure 38) and 33 per cent higher than September 2015.

• Using the recalculated workforce figures following the introduction of the new definitions, in July 2016 the total number of full-time equivalent (FTE) staff working in hospital and community health services (excluding, for example, general practitioners) was more than 1.027 million (Figure 39).

• Compared to July 2015, there has been an increase in all staff of 22,132 FTE posts (2.2 per cent). This has been across all staff groups: consultant numbers have increased by 3.2 per cent; managers by 3.6 per cent; scientific, therapeutic and technical staff by 2.2 per cent; nurses, midwives and health visitors by 1 per cent.

• C difficile infections remained below 400 cases a month between March and July 2016 but increased to 425 in August and September 2016. The number of methicillin-resistant Staphylococcus aureus (MRSA) infections remains low – a total of 31 in September across England (Figure 40).

• The number of reported methicillin-susceptible Staphylococcus aureus (MSSA) infections in September 2016 have decreased to 232. Similarly, numbers of E coli infections decreased.

Source: ResearchOne

In this section, we have used data from ResearchOne, a health and care research database created using records held on TPP’s SystmOne, one of the main providers of information systems in general practice in England to compare the amount of activity experienced in a sample of 202 practices (approximately 2.5 per cent of all practices in England) in the first two quarters of 2016/17 with the same period in 2014/15.

Our sample shows the number of patient contacts with GPs has changed significantly over the past two years, with a 9.9 per cent increase in contacts with patients in quarters one and two of 2016/17 compared to the same period in 2014/15. The increase in activity is greater in telephone contacts (an increase of 36.6 per cent) than face-to-face contacts (an increase of 6.1 per cent) (Figure 41). Part of this overall increase in activity can be attributed to an increase of approximately 4.6 per cent in the registered patient list size of the practices in our sample over the same period.

As respondents to our GP survey reported, the sample data also suggests that activity is being shifted away from face-to-face contacts towards telephone activity, face-to-face contacts falling from an average of 92 per cent of activity in quarters one and two 2014/15 to 89.5 per cent in quarters one and two 2016/17.

Breaking this activity down by age of patient, the data suggests that, although in most age groups there has been an increase in the number of contacts with clinical staff of around 9 per cent between quarters one and two 2014/15 and quarters one and two 2016/17, there was much higher growth for patients 85 and over, with 26 per cent more contacts over the same time period.

If we consider the number of appointments per patient seen (ie, the contacts for people who have had a face-to-face or telephone contact in each practice within the period studied, not the number of patients on each practice list), we can see that the largest growth in number of contacts has come in those aged over 75 (Figure 42).

GP referrals to secondary care in England

GP referrals to secondary care are growing (Figure 43) at a rate that outstrips population growth. While this causes increased activity for secondary care, it also generates additional work for general practice both in making the initial referral and following up tasks once the patient has been seen in secondary care.