Surgeries/Referrals/Procedures Do Have a Maximum Wait Time?

In the past weeks I have heard and answered many questions about people waiting huge amounts of time for surgeries, so let’s go over the facts, and your rights again.

Law that regulates maximum wait time for surgeries:

Each autonomous community (AACC) has a maximum wait time for surgeries. It can be found by googling “garantia quirurgica” and adding your AACC.

For Andalucía, this is the law.

what are the maximum wait times?

• 120 days for these procedures (they included carpal tunnel surgery, hip prosthesis, cataracts, gallbladder and many more).
• 180 days for these procedures.

As I have seen, many AACC have the same wait times of 180 days, I have only seen the 120 days for Andalucia, I would be thankful for information about different AACC.

When you go to a consultant, you will be given a form filled by them, with that you will go to waitlist desk in ´atención al usuario´ and request your inclusion in the wait list. You will be given a paper for you to keep.

VERY important tip: you must check

• that it says that your surgery is included in the law of guarantees (usually at the bottom). If this is the case the you KNOW that you will not wait more than the time given by the law of your community.
• that it concurs with the “label” given by your doctor: if they put in the paper they gave you “preferente”, check that in the paper the administration gives you it says ¨preferente¨ also! I have had cases where the preferente was changed to “normal” (not maliciously I hope), and this changes the time you have to wait ( preferente gets less time, BUT this is NOT written anywhere, it changes from hospital to hospital and from department to department, depending on resources and demand).
• when you go to be included in the wait list, they might ask you if you want the surgery done in another, private hospital that is helping with the wait list. This happened to me. STOP! private does NOT mean BETTER. I already knew I wanted my surgery to be done in that hospital, so I said no: beware that this brings the LOSS OF THE GUARANTEE. If this happens to you, I would stop the process: say that you must think about it, they will give your paper back, and it’s time to do research with GP and friends. Ask your GP what would he/she do, ask around, ask the consultant what he/she thinks, and after you have made your decision, go back. Usually “easy” (and I put ” ” because any surgery can go wrong.,.)  surgeries are safe to have in private hospitals (these hospitals will not be the swanky ones, mind you), as they handle a lot of cases, so they have good experience.

So, you have a surgery that in the law says it must be done in 180 days, it´s day 170, what do you do?

The law says clearly (at least in the Andalucía one, check your AACC) that they cannot go over the wait time, so if that day is approaching it is time to go and talk to the people at the waitlist desk. If you go one month beforehand they will tell you to relax (in other words…), but if you go with only 15-10 days to go, you can put more pressure.

10-15 days before the surgery you might have the choice (depending on your AACC) to have the surgery done in a private place if your hospital is incapable of handling volume. Again, it´s time to think. When you have made a decision, go and explain  that you want to make use of your right to go to a private (called “concertado” because it has “concierto”, an arrangement , with the NHS). If you are not interested in this option, and the date is approaching, simply write a letter complaining that the guarantee is coming to an end, and that the surgery by law, must happen. You can also write a letter to the administrative, director, medical director and chief of service, just write one letter CITING THE LAW, this usually makes them tick!

I have not had any luck with advising patients going to the A&E. The usual complaint with a long wait for a surgery  is pain, so they give them pain killers and send them home. The surgery wait list is a very difficult system to move. But of course, it can’t hurt to try!

Maximum wait time for diagnostic procedures:

30 days.

this is the law for Andalucía, but again, I have seen the same thing in many other AACC.

When you are given a referral for a diagnostic procedure, in some instances you will be given an appointment straight away, in other the famous “we will call you” happens. With this last scenario, the same things that applied for surgeries apply for procedures:

• make it clear to the clerk that it says “preferente” in the paper.
• again, check that the procedure is included in the law, it should say so in the paper they give you. You cannot contest this, if it’s not included, its the law. But at least you’ll know if you have the guarantee or not. If in the paper it is not stated if the procedure is under guarantee or not, ASK.
• if it says urgent, this is what will happen: it will go via internal mail to the administrative section, and they will let the department know, a doctor will see it, and they will decide. The problem? This can take up to a week in my experience, so a quick fix would be to go through with that, but take a photocopy for yourself of the original paper. With that, go to the department where you are supposed to have the procedure done, and give the paper to the secretary, explaining that it’s an  urgent procedure and you just want to leave the paper with them but that you also left one with the proper administrative person (so they don’t think you are “breaking the chain of command”).  This may speed things up.
• if the 30 days are approaching and you have not heard anything, go to the hospital and as I explained with surgery; say that you know the period is coming to an end, what’s going on? If no solution is given, the complaint letter must be written.
• in Andalucía, as with surgeries, if the guarantee is not fulfilled, you can ask to go to a private “concertado” centre. Keep that in mind when you write the letter.

Maximum wait wait time for referral to a consultant:

60 days, same law

When you are given a referral to a consultant, in some instances you will be given an appointment straight away, in other the famous “we will call you” happens. With this last scenario, the same things that applied for surgeries apply for referrals:

• make it clear to the clerk that it says “preferente” in the paper.
• if it says urgent, this is what will happen: it will go via internal mail to the administrative section, and they will let the department know, a doctor will see it, and they will decide. The problem? This can take up to a week in my experience, so a quick fix would be to go through with that, but take a photocopy for yourself of the original paper. with that, go to the department where you are supposed to have the consultation, and give the paper to the secretary, explaining that it’s an urgent referral and you just want to leave the paper with them but that you also left one with the proper administrative person (so they don’t think you are “breaking the chain of command”). This may speed things up.
• if the 60 days are approaching and you have not heard anything, go to the hospital and as as I explained with surgery; say that you know the period is coming to an end, what’s going on? If no solution is given, the complaint letter must be written.
• in Andalucía, as with surgeries, if the guarantee is not fulfilled, you can ask to go to a private “concertado” centre. Keep that in mind when you write the letter.
• here is where the A&E can make a difference. I have had patients with serious diseases that the gp gave preferente, not urgent (as I thought he should have done) referrals. In this case, go to the A&E with every scrap of paper regarding your disease (the one you are being referred for) and say to the A&E doctor: I was given a preferente referral for this, I’m waiting for an appointment, but I’m really scared, or worried, or feel bad (whatever applies to you, remember : EMBELLISH). In this case, and if the situation guarantees it, the A&E doctor will call the consultant on call (this is why you should go during working hours to assure that they are in the hospital!), and in my experience the situation could change rapidly.

I have a patient with acute leukaemia  that his gp gave a preferente referral, this was september (yes, you read correctly,I don’t know what he thought could be urgent, if acute leukemia was not….), he was given an appointment for october. With my advice he went to the A&E, as soon as they saw the diagnosis, they called the haematologist. When the october appointment came, he had already had his first chemo…….

Know your rights and fight for them.

Please note: The information provided is based upon our understanding of current legislation. It is not legal advice but is provided freely to enable you to be properly informed. We recommend that if you are considering taking action, you should seek professional advice.