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Tale of Two Cities

How can two Cities 40 miles apart offer such radically different access to NHS services? Sheffield with a population of around 569,000 and Nottingham with around 354,000 have approached Patient Choice and demand management in two completely different directions dictated by the attitude of GP’s and the Local Clinical Commissioning Groups (CCG). Nottingham has opened up the market to competition in providing NHS services whilst Sheffield has limited competition and taken steps to restrict Patient Choice to the point where they have almost removed completely, the ability of patients to choose where they have their care provided from.

Nottingham NHS Choice

By NHS services the examples shown below are for diagnostic examinations, Ultrasound, MRI, Echocardiograms, Hearing Test, Endoscopies and similar. The data covers nine weeks  at the end of 2015, the most recent available from the HSCIC web site. All the numbers shown are for GP referrals to a range of providers from NHS Hospitals, Foundation Trusts, Clinical Commissioning Groups, GP Practices and Any Qualified Providers (AQP). Details of the data selected are included at the end of this article.

Using Maptive a data geo-locating software the first map shows at a high level the significant variation between the two cities but as we explain in this article you need to zoom in to a local level to see the true variations.


Sheffield Nottingham AQPThe data uses the postcode of the service provider site and contains details of the waiting time in days to book an appointment and the GP practice referring the patient. The location of the blue label and total displayed is geomass-centric to the Provider site postcode and volume of bookings analysed and therefore should not be used as a definitive count for an area. There is no patient identifiable data included in the accessible data.

The Sheffield data includes bookings in Barnsley and Rotherham and you must zoom in to the City of Sheffield before the picture becomes clear.

The Nottingham data includes bookings in Newark, Grantham and surrounding smaller communities. Zooming in, the number of bookings are so great that to see the actual sites, two views are required showing the North and Central Nottingham areas.


City of Sheffield Bookings to Diagnostic Service Providers

Sheffield e-Referral NHS bookings

Only three sites within the City of Sheffield offer access to diagnostic services for GP referrals. All are located along the same corridor to the west of the city in the affluent area of Hallam.

The most significant number of referrals is at the Royal Hallamshire Hospital, part of the Sheffield Teaching Hospitals NHS Foundation Trust with 251 Hearing Test/Assessments. Waiting times for an appointment are around 30 days, a situation that you do not find in many CCG areas where this type of service is commonly available on the high streets at Boots, Specsavers, Community Clinics  or similar. These CCG’s have commissioned through the Any Qualified Provider route and patients benefit greatly through shorter waiting times, convenience and less hassle such as hospital parking space and payment.

The other two sites are Private Hospitals, BMI Thornbury Hospital and Claremont Hospital. 11 out of 26 bookings at Thornbury and 12 out of 46 at Claremont are from Sheffield CCG. Just 23 out of the 72 endoscopies undertaken were from the Sheffield CCG area, the rest are from North Derbyshire and Barnsley CCG’s.

The waiting times at these two sites are between 3 and 5 days, a situation that is not the same for those patients who are forced to wait for their GP to post a paper referral to the main hospital provider, Sheffield Teaching Hospitals NHS FT. waiting times are likely to be up to 20 weeks  and little opportunity for patients to select an appointment date to suit their work and family life.

Patients living to the North and East of Sheffield have no local access to diagnostic services yet have the poorest health outcomes. It seems strange that GP’s and their CCG should obstruct patient choice and access to diagnostic services, especially to those who are in most need.


City of Nottingham Bookings to Diagnostic Service Providers

Nottingham NHS


In Nottingham a GP can readily request an ultrasound scan or endoscopy and the patient can arrange an appointment at over 20 different sites around the city, most located in GP practices or community clinics, avoiding trips to the main hospitals and the cost and difficulty of parking at hospital sites.

Waiting times at the NHS hospital are around 30 days for an appointment for endoscopy and just 5 days at the Private Hospital. For ultrasound, appointments are within 1 to 23 days at all sites.

North Nottingham Bookings to Diagnostic Services by Site

NHS Diagnostics Nottingham

The six sites in North Nottingham are within a 1.5 mile radius of each other and include GP practices, a Private Hospital, an NHS Hospital and a Clinic. They are close to large residential housing estates and are complimented by the sites around the Centre of Nottingham.


Central Nottingham Bookings to Diagnostic Services by Site

NHS Nottingham

In Central Nottingham the waiting times for endoscopy is 15 days and ultrasound varies between 1 and 23 days depending upon the site.

The volumes are significant for just a 9 week period and represent much greater patient choice to direct access diagnostics.

A stated benefit of GP direct access is a reduction in the number of GP referrals to hospital consultants which are unnecessary. Referrals to hospital consultants often have to wait weeks before they see the doctor and can then have to wait further weeks for the ultrasound scan to be done and then face a subsequent wait for an appointment for the results. This process adds to the demands on providers to meet the 18 week referral to treatment (RTT) and consume resources in managing all the stages in the process.


How much Nottingham patients benefit from choice and timely access to diagnostics in comparison to Sheffield, if at all, requires much more detailed analysis. It is likely that Sheffield GP’s do refer similar numbers of patients but deny patients any choice. They are left waiting until a letter drops through the letterbox with a prescribed appointment date rather than one chosen by the patient to fit in with their work and home life.

Intuitively the varied locations and choices for patients is a good thing. Fears that the private sector are “cherry picking” is miss founded. Patients pick and choose, not the Provider, the NHS payment tariff is not generous and the private/independent sector are releasing spare capacity to the benefit of NHS. With ever increasing demand upon the acute care providers it surely makes sense that the first priority is to meet this demand. Why keep acute admissions waiting in a bed for an ultrasound scan or endoscopy while the department works its way through the elective backlog when clearly elective capacity already exists outside in the Independent Sector.

There is a vast amount of data held by the NHS and the HSCIC with the potential to benefit patients, service providers, commissioners and remains unused. This data and similar is available for the whole of NHS England. The only limitation is the degree to which a CCG area uses e-Referrals. Even the lack of use tells you something about how choice is offered, or not, and the extent to which competition is being used to improve access.

If you would like to find out more about this data and how it can help you find a service with shorter waiting times or a service closer to home/work, use our Contact Form.

If you are interested in using a mapping software tool this information has been collated through Maptive an easy to use and powerful desktop package.

The source data is from the Health & Social Care Information Centre HSCIC and can be found on their web site

For previous articles on NHS Sheffield CCG and other poor performing CCG’s Click Here

For a summary of the data used click on this link Tale of Two Cities data