Intended for healthcare professionals

Opinion Critical Thinking

Matt Morgan: Jumping the queue to make it smaller

BMJ 2023; 383 doi: (Published 10 October 2023) Cite this as: BMJ 2023;383:p2318
  1. Matt Morgan, consultant in intensive care medicine
  1. Cardiff, UK
  1. mmorgan{at}
    Follow Matt on Twitter: @dr_mattmorgan

The NHS waiting list in England reached 7.57 million at the end of June. It’s now more than double the population of Wales, with 383 000 patients waiting more than a year for treatment.1 But, waiting lists apart, the NHS is still a very efficient organisation overall. International comparisons show that it has some of the highest use of cheaper generic medicines and lowest budgets spent on administration.2 Any drive towards car factory levels of productivity,34 for example, may therefore produce little additional mileage.

The alternative of pouring in more staff takes time, is expensive, and doesn’t tackle the exit flood that needs to be stopped.5 However, with sickness rates of NHS staff at 5.6%, special treatment may be needed.6 These reported rates translate to a staggering 74 500 full time staff off sick in 2022, including 2900 doctors and 20 400 nurses. The true extent is probably even higher, given low reporting levels in some staff groups.

I’ve previously written about how “VIP” treatment in healthcare can be damaging.7 After I was spotted at my dad’s bedside some years ago, he was given a scan he didn’t need. This nearly resulted in him having a major operation for a condition that was being managed perfectly well with simple treatments. But I’d draw a distinction between this “special” treatment and looking after your workforce by ensuring that they receive timely help.

Giving NHS staff prompt access to diagnostics and interventions would speed up their return to work, improve staff retention, and ultimately be better for patient care. Expedited care of colleagues already happens in some cases, through hushed corridor conversations and loopholes that may bypass safety protocols. Colleagues may be seen at the end of a clinic, when notes aren’t available or referral pathways have been flexed. Having a transparent, non-apologetic process to prioritise all NHS staff would help to ensure a system of safe and joined-up care. Staff could use some of the 8% of appointments or operations that are currently cancelled at the last minute, given that they’re likely to work on site or close by.8

This isn’t rocket science (or brain surgery). Staff discount schemes and health benefits form key parts of retention policies in most large organisations. A discount on your access to healthcare will be an increasingly valuable resource in an ageing workforce—and one that the NHS is well placed to deliver.

Most importantly, however, there will be a sweet spot in mathematical modelling that would allow NHS staff to “jump the queue” while also resulting in a shorter overall waiting time for other patients. Although this may go against the British meme of being world class queuers, Kate Bradley, a lecturer in social policy at the University of Kent, has said, “When people tackle breaches of queue discipline it’s not really the notion of fair play that is driving them, it is protecting their own interests.”9 I’d argue that prioritising healthcare for NHS staff will be in the interests of all: jumping the NHS waiting list may actually make it smaller. Let NHS staff in, and they’ll let you go in front.


Thanks to Meurig Chapple and Matt Wise for sharing their idea about prioritising NHS staff on the waiting lists and using cancelled appointments.


  • Competing interests: I have read and understood BMJ policy and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Matt Morgan is an adjunct clinical professor at Curtin University, Australia, an honorary senior research fellow at Cardiff University, UK, consultant in intensive care medicine in Cardiff, and an editor of BMJ OnExamination.