Andrew Donald, chief operating officer, Birmingham East
& North Primary Care Trust:
"We achieved the 18-week target in September 2008. The average person now gets to outpatients within four weeks. But you can only sustain this by pulling out of the system all the waste in the various pathways. For example, in orthopaedics the consultants say too many people are going to outpatients who don't need to. We now have a project with a single point of access for all people with musculoskeletal conditions. By 2010-11 we expect only 30% will need to go on to see a consultant and receive hospital treatment.
"My gut feeling is that we will see further redesigns in particular specialties to bring the waiting times down further. So you won't necessarily see the consultant [at outpatients]; you may see the specialist nurse, and that will create more capacity for doctors."
Graham Archard is a GP in Christchurch, Dorset
"Because of new guidance from the National Institute for Health and Clinical Excellence, I'm referring people with basal cell carcinoma every week, when two years ago I was treating them myself. Dermatologists and surgeons are tearing their hair out about the number of such referrals.
"In my practice, everybody's seen on the same day. We worked our socks off to get to that point but now there's no extra work in maintaining the situation. You're seeing the same number of patients but there's no backlog. If you have shorter waiting lists you do tend to refer more. If someone has to wait a year for a psychological assessment, what's the point? But if it's possible for people to be seen within six weeks, referral rates will go up. And, of course, it's always possible that extra demand could mean waiting times go up."
Paul Jenkins is chief executive of mental health charity, Rethink
"If your mind is broken and you need psychological therapies, you may have to wait over a year, if you get them at all. I would like to see a mental health target comparable to acute care. Targets have made people look at how the system works and how to improve it. That includes unblocking the pathway, ensuring people have somewhere to go after being in hospital and using operating theatres more efficiently.
"Mental healthcare is probably ripe for that kind of thrust. Targets force people to confront issues. Something about guaranteed right of access would force staff to consider other ways in which access could be improved. A fundamental requirement for hitting these targets would be increasing capacity. At the moment there isn't enough capacity in the system to deliver the kind of care people should expect."
Jonathan Fielden of the British Medical Association's consultants
"If you look at a system with no limits on capacity such as private practice, you can have an operation within a matter of days or weeks. Patients should be told that their trusts can perform better and there should be an open debate about why that's not happening.
"Trusts should liaise with their patients to see what their ideal time would be. It may well be that they would be happy [to wait]. Having said that, we have always disliked targets because we should be treating patients at the point of their clinical need rather than to meet an artificial target. It may well be, for instance, that for some people waiting 18 weeks or longer for treatment is appropriate."
Compiled by Andrew Cole
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