Waiting times for surgery - Inheritance for primary care organisations in Trent

Aims: To determine differences in waiting times for surgical procedures between primary care organisations in Trent Region and the extent to which these were explained by characteristics of the primary care organisation and by patient factors such as age, gender and deprivation. Design: Cross-sectional survey of routinely collected data. Setting: Forty-eight primary care organisations in Trent Region, UK. Subjects: All patients admitted for seven surgical procedures between 1 April 1993 and 31 March 1997: female breast cancer surgery, colon cancer surgery, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, cataract surgery, hip or knee surgery in patients over 65 years. Method: Comparison of median waiting times from decision to operate to surgery for 48 different primary care organisation; correlation between overall ranks of waiting times and characteristics of the primary care organisation; multilevel analysis allowing for primary care organisation variation to determine the contribution of the patient age, sex and deprivation. Results: There were wide variations in median waiting times between primary care organisations, ranging from 2.6-fold for breast cancer surgery to 14.3-fold for percutaneous transluminal coronary angioplasty. These differences were not explained by patient factors or by characteristics of the primary care organisation. Conclusion: If the new strategic health authorities are to performance manage primary care trusts, and the primary care trusts are to be given responsibility for reducing health inequalities and improving waiting times, the differences in starting points need to be recognised and, if possible, understood.