Thousands of patients accidentally removed from NHS waiting lists

At least 2,000 patients have accidentally “dropped off” NHS waiting lists since 2018, according to a new report by the health watchdog.

The Health Services Safety Investigations Body (HSSIB) warned that the electronic system widely used by GPs to refer patients for specialist care “was not designed to manage the current volume of referrals” in the health service.

It comes as an investigation found that a number of incidents involving thousands of patients disappearing from waiting lists have occurred since 2018.

The NHS e-Referral Service (e-RS) generates digital worklists for services such as hospitals.

Referrals are automatically removed when an action, such as booking a patient an appointment, is performed or when 180 days pass with no action, which was designed to slash the risk of large worklists impacting performance.

However, the HSSIB warned that this 180-day function “also creates a hazard” and puts people at risk of missed or delayed care.

Its investigation found there were incidents where referrals disappeared from worklists without being flagged, both for unknown reasons and after 180 days of no action.

In 2018, some 72 referrals “disappeared” from an appointment slot issue (ASI) worklist, which contains referrals where there are no slots available for booking at the time of the appointment search. The following year, more than 1,000 patients also “potentially dropped off” the e-RS ASI worklist.

And in 2023/24, around 1,000 patients had to be added back onto a worklist after “dropping off” after six months.

They had not been booked into an appointment because of “clinic capacity constraints”, the HSSIB said, and the issue was only spotted when GP practices raised concerns that their patients had not heard from the hospital.

Nick Woodier, senior safety investigator at HSSIB, said: “Patients waiting for a hospital appointment are often living with symptoms and the worry of not knowing when they will be seen.

“If a patient’s referral is removed from a list without warning, they may wait far longer than they should.”

The report said that while the 180-day function is not new, it has not been formally documented as a potential patient safety risk.

It added that the “level of risk is difficult to determine” but has “potentially increased in light of demands on outpatient services and longer waits for appointments”.

The latest data from NHS England shows there were an estimated 7.37 million treatments waiting to be carried out at the end of August, relating to 6.24 million patients.

This is up from 7.33 million treatments and 6.21 million patients at the end of July.

Some 113,339 people had been waiting more than a year, up from 111,379 people

The HSSIB highlighted that the e-RS system “was not designed to manage the current volume of referrals seen across the NHS”, particularly since the pandemic.

The report comprises the second set of interim findings from the body’s probe of electronic patient record systems.

The HSSIB has called for hospitals and other healthcare providers to check they have reliable processes in place and to ensure referrals are not removed from their lists.

It also said that NHS England is updating its national clinical risk documentation to recognise the risk and will share this with trusts.

Mr Woodier added: “This is a risk created by the system itself, but it has created an immediate patient safety risk, which is why we have published an interim report.

“Our report sets out practical steps NHS trusts must take straight away to keep patients safe.”

Rachel Power, chief executive of the Patients Association, said: “We regularly hear from patients who feel forgotten by the NHS, and that they have been left to chase their own care.

“HSSIB’s finding that referrals can disappear from NHS worklists without healthcare providers realising shows how easily this can happen and raises serious questions about how the system is failing patients.

“Patients should be able to trust that when they are referred for care, their referral will be followed up. They should not have to worry that they have been lost in the system, or carry the responsibility for making sure the NHS does not lose track of them.

“Managing referrals is too often treated as an admin task, but it is part of patients’ clinical care and when it fails, people can come to real harm.

“NHS England and local trusts must now put in place clear accountability, effective referral tracking and proper administrative support so that no patient falls through the gaps. Any patient who may already have been affected must be found and contacted.”