Surgical Insourcing

University Hospitals of Leicester NHS Trust

Background

University Hospitals Leicester (UHL) is one of the biggest and busiest NHS Trusts in the country, serving one million residents and providing a broad range of specialist services.

Each year the Trust typically performs over 54,000 operations across all surgical specialties, with a total of 48 operating theatres across their three main hospital sites. The Trust is also a ‘super specialised’ centre with many patients travelling from around the country to undergo specialist procedures. UHL also has a leading robotic surgery programme used for specialised Urology and Gynaecology procedures.

The Challenge

At the end of 2021, UHL was one of five Trusts in the UK with the highest elective care backlogs. Their waiting list included over 110,000 patients, almost 2,000 of whom had been waiting more than two years to start treatment. To meet NHS Elective Recovery Plan targets, UHL urgently needed support to resource a significant increase in surgical activity.

The Solution

Medacs rapidly mobilised a new Clinical Insourcing service for UHL, initially focused on managing weekend theatre sessions for General Surgery, Paediatrics and Urology.

An allied workforce model was used, with weekend teams comprising key members from UHL’s consultant clinical team alongside a full externally supplied team of Nurses, ODPs and Anaesthetists.

The first weekend theatre sessions took place approximately three weeks from contract award and a pool of over 80 surgical staff with the right skills to support all specialties was quickly built.

A 'hands on' approach

Experienced Medacs staff attend onsite every weekend to support theatre floor management. Here is an example of how this adds value:

“One weekend a patient with a pacemaker turned up and there were understandable safety concerns as this was not flagged in their pre-op. Ordinarily this would have resulted in an immediate cancellation, but as the co-ordinator on site I was able to liaise with the surgeon, anaesthetist, recovery and ward nurse staff, as well as bed management. After some negotiation, including securing an overnight bed for increased monitoring, everyone agreed that it was safe for the surgery to go ahead on the day. Having waited two years for their operation, the patient was extremely grateful”

Anne Anderson – Director of Nursing and Clinical Governance

Integrating Complexity

Medacs is also now managing an in-week pre-operative assessment service for UHL and has drafted in a team of skilled cardiac ICU nurses to support the Trust with complex cardiac surgery.

Over time, the complexity of the weekly case mixes has increased, with UHL trusting Medacs to manage specialist colorectal procedures, complex gynaecology procedures (e.g. Total Abdominal Hysterectomies) and even major cancer cases. All surgical sessions are reviewed and audited in depth the following week by Medacs’ independent clinical governance team, with expert clinical coding support lent to accurately classify procedures.

Results

Over 1500 patients cleared in 12 months
Cleared 104-week waits in 3 specialties in line with NHS July 2022 target
Estimated 10% Surgical Productivity Increase
No lists cancelled due to staffing shortages with reserve staff ready to backfill last minute
250+ complex cases (ASA3+) safely cleared with substantive consultants working alongside a trusted allied team
Positive patient feedback shows the value of an efficient, stress-free service

“

Medacs has helped immensely to manage the significant waiting list backlog at University Hospitals Leicester. The service is excellent and all their staff are proactive, efficient and well versed with Trust theatre protocols. I have had very positive feedback from everyone involved

Consultant Clinical Lead