title: Does limiting long-term follow-up for breast cancer allow all referrals to be seen in 2 weeks?
abstract: BACKGROUND
  The UK National Institute for Health and Clinical Excellence (NICE) recommends that breast cancer follow-up should be limited to 2-3 years stating this will 'release resources' making it 'possible for all women with breast symptoms to be seen within 2 weeks'. In 2000, breast cancer follow-up services in North Bristol were redesigned to reflect evidence-based best practice. The aim of this paper is to assess the impact of this policy on numbers of follow-ups, clinic capacity and waiting times.
  
  
  METHODS
  Data regarding the numbers of new and follow-up patients seen in breast clinic between January 2000 and December 2005 were collected from the hospital Patient Administration System. New patients were categorised as either 'routine' or 'urgent' according to '2-week wait' rule guidelines. Median waiting times were calculated for each group and nominal appointment times assigned in an attempt to assess the effect of any changes on clinic capacity.
  
  
  RESULTS
  The number of follow-ups decreased by 33% as a result of the new policy. Numbers of referrals over the same period, however, increased by 14%. Routine referrals declined, but there was a 27% increase in '2-week wait' patients. Waiting times for routine appointments initially decreased in response to reduced follow-up, but then rose as the number of '2-week wait' referrals increased.
  
  
  CONCLUSIONS
  Reducing long-term follow-up is a simple and effective method of increasing clinic capacity but its effects are inadequate and transient in the face of increasing service demand. Additional innovative and creative strategies will be required if all breast patients are to be seen within 2 weeks.
authors.affiliation: Breast Care Centre, Frenchay Hospital, Bristol, UK. simon.cawthorn@nbt.nhs.uk
authors.forename: S
authors.initials: S
authors.lastname: Potter
authors.forename: S
authors.initials: S
authors.lastname: Govindarajulu
authors.forename: M
authors.initials: M
authors.lastname: Shere
authors.forename: F
authors.initials: F
authors.lastname: Braddon
authors.forename: J
authors.initials: J
authors.lastname: Turner
authors.forename: A K
authors.initials: AK
authors.lastname: Sahu
authors.forename: S J
authors.initials: SJ
authors.lastname: Cawthorn
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000628:therapy*; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors; D014850:Waiting Lists