The report on NHS backlogs and waiting times in England from the National Audit Office (NAO) warns that long waits for elective and cancer care have been growing since well before the pandemic - and highlights that rising waits are adding to intense pressure on primary care.
Under regulations in place since 2013, at least 92% of patients on NHS waiting lists must begin treatment or be seen by a specialist and leave the waiting list within 18 weeks.
In 2010, around 200,000 people were waiting more than 18 weeks for treatment - around 8% of the total awaiting treatment at the time. But by February 2020 - the month before the impact of the COVID-19 pandemic on NHS waits began - this figure had risen to nearly 750,000, around 17% of the total waiting list.
By September 2021, the watchdog says 1.95m people - around a third of the total 5.8m now awaiting treatment - had been waiting more than 18 weeks. More than 300,000 people had been waiting more than a year, the NAO report says.
For cancer care, numbers breaching the 62-day referral-to-treatment target have been rising since the first half of the last decade. By September 2021, more than half of patients waiting for treatment for lower gastrointestinal cancers had been waiting more than 62 days - along with more than a third of those waiting for lung or urological cancer treatment.
For both elective and cancer care, significant regional variation exists - with waits significantly longer in parts of England.
The report warns that delays for care in parts of the NHS such as primary care are 'exacerbated by the backlogs in hospital and cancer care'.
It warns: 'GPs, for instance, also often have to offer additional support to patients who are facing long waits. The longer a patient has to wait for treatment, the longer they may experience pain, anxiety or other symptoms. Such effects may temporarily reduce quality of life, prevent people from working, or lead them to seek relief through additional visits to the GP or urgent and emergency care services, placing further strain on the NHS.'
GPs at last month's LMCs conference for England hit out at the transfer of workload from hospitals to primary care. But the NAO report reflects warnings from GPs that in addition to the direct transfer of work - such as hospitals asking practices to carry out tests, prescribing or other work that should be part of hospital care - practice workload is also being driven up by demand for ongoing appointments from patients who are waiting longer and longer for hospital care.
Data on GP appointments show that in October 2021 practices delivered more than 30m appointments - and that total appointments are now in excess of pre-pandemic levels.
Responding to the findings, BMA chair Dr Chaand Nagpaul said: 'This report lays bare the impact of the pandemic on non-COVID care, the resulting backlog and needless suffering that thousands of patients are now enduring as a result of the current delays in our health service.
'The NHS went into the pandemic woefully underprepared, understaffed and with inadequate capacity – meaning services across the system were forced to suspend all but the most urgent work.
'For GPs, they are working as hard as they can to meet patient demand, being deluged with patient queries about their hospital waits and appointments, and are delivering more appointments than before the pandemic.'
The BMA chair urged the government to 'start giving the NHS the support, resources and capacity it needs'. He added: 'The government said at the start of this crisis that it would give the NHS "whatever it needs", and this must be realised as soon as possible.'