Patient Access Policy - qegateshead.nhs.uk · Patient Access (Waiting List/Waiting Times) Policy v7...

Policy No: OP12

Version: 7.0

Name of Policy: Patient Access (Waiting List/Waiting Times)

Policy

Effective From: 18/04/2018

Date Ratified 27/03/2018

Ratified Finance and Performance Committee

Review Date 01/03/2020

Sponsor Director of Strategy and Transformation

Expiry Date 26/03/2021

Withdrawn Date

Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no

assurance that this is the most up to date version

This policy supersedes all previous issues

Patient Access (Waiting List/Waiting Times) Policy v7 2

Version Control

Version Release Author/Reviewer Ratified

by/Authorised

by

Date Changes

(Please identify

page no.)

1.0

2.0

June 2006 Trust Policy

Forum

June 2006

3.0 March 2007 BSDC March

2007

4.0 Aug 2008 BSDC Aug 2008

5.0 17/12/2009 Steve Atkinson

Sharon Pearson

BSDC 05/10/2009

6.0 27/02/2014 Julie Rush Patient,

Quality,Safety &

Risk Committe

17/01/2014

7.0 18/04/2018

Julie Rush/Denise

Reay/Steve

Lawson

Finance and

Performance

Committe

27/03/2018

Full review

following internal

audit, updated

guidance and

recommendations

from NHSI/NHSE

access policy

master class


Contents

Section Page

1 Introduction ...................................................................................................................... 4

2 Policy scope ....................................................................................................................... 5

3 Aim of policy...................................................................................................................... 7

4 Duties (Roles and responsibilities) .................................................................................... 7

5 Referral Management ....................................................................................................... 9

6 Appointment Management .............................................................................................. 10

6.1 Appointment Booking Management

6.2 Capacity and appointment slot issues

6.3 Patient cancellations

6.4 Clinic attendance

6.5 Clinic outcome

6.6 Did not attend

6.7 Patient Transport

6.8 Clinic administration

6.9 Clinic format

6.10 Clinic change management

6.11 Outpatient waiting list validation

6.12 Management of Inpatient & Daycase waiting list

6.13 Treatment management

6.14 Inpatient & Daycase cancellations and suspensions

6.15 NHS Constitution/Patient Choice

7 Training ............................................................................................................................. 22

8 Equality and diversity ........................................................................................................ 22

9 Monitoring compliance with the policy ............................................................................ 22

10 Consultation and review .................................................................................................. 23

11 Implementation of policy (including raising awareness) .................................................. 23

12 References......................................................................................................................... 23

13 Appendices ........................................................................................................................ 24-51


Patient Access (Waiting List/Waiting Times) Policy

1. Introduction

This Policy is issued and maintained by the Director of Strategy and Transformation on behalf of The

Trust, at the date identified on the front sheet, which supersedes and replaces all previous versions

This is the Trust Patient Access (Waiting List/Times) Policy (OP12) for Gateshead Health NHS

Foundation Trust. The document has been developed with consultation throughout the local health

community and supports the NHS Plan. This has included partnership working across the whole Health

Community

The successful management of patients who wait for all appointments and elective treatment is the

responsibility of a range of staff working within all sectors of the NHS, including Trust staff,

Commissioners, GP and patients. Service commissioners must ensure that service agreements are

established with sufficient capacity to ensure that no patient waits more than the guaranteed

maximum time specified in the NHS Plan. Hospital medical staff, managers, secretarial and clerical staff

all have an important role in treating patients delivering a high quality, efficient and responsive service

and managing waiting lists effectively

This policy is a reference document which applies to the management of all waiting lists held by

Gateshead Health NHS Foundation Trust – inpatient, day case, outpatient, therapy and diagnostic

services and must be adhered to by all staff. The policy will be available to all those involved in

organising access to the Trust’s services including the general public

It is the Trusts intention to continue to modernise its outpatient and inpatient treatment management

systems in line with the NHS Plan. A range of booking systems have been developed to support this.

National developments such as NHS e-Referral Service and local systems such as ICE Pathology and

Radiology requesting tools have been rolled out in collaboration with General Practitioners, CCGs and

Trust clinical and administrative staff.

The NHS Constitution came into effect 1st April 2010 and sets out the following rights for patients:

• The NHS is making sure that you are seen as soon as possible, at a time that is convenient for

you. To do this, the NHS Constitution gives you the right to access services within maximum

waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable

alternative providers if this is not possible

• This right is a legal entitlement protected by law, and applies to the NHS in England from 1st

April 2010. The maximum waiting times are described in the Handbook to the NHS

Constitution which you can find on our website. Gateway reference: 13676

www.Gatesheadhealth.nhs.uk/constitution

If any staff member has any queries regarding this policy they should contact their immediate line

manager in the first instance.

There may be occasions when situations arise which are not covered by this document. In such

circumstances the appropriate line manager should be contacted. If further advice is required,

guidance should be sought from the Business Unit, Associate Director or Departmental Manager for

that service.

The features in this policy are consistent with advice given in:

• NHS Improvement Plan

• Tackling Hospital Waiting: the 18 week pathway and Implementation Framework


• RTT Consultant –led watiting time Rules Suite Oct 2015

• NHS Constitution Access to Services – October 2015

• Delivering Cancer Waiting Times – A Good Practice Guide

Trust Commitment

The aim of this health community is to provide good access to high quality healthcare and Gateshead

Health NHS Foundation Trust is committed to the following:

• All patients will be treated according to clinical need within the resources available

• To establish a consistent approach to patient access across Gateshead

• An integrated and sustained approach to waiting list management

• Systematic approach to developing referral protocols and guidelines with GP’s,underpinned by

regular audit to monitor effectiveness

• Effective two way communication with patients and their GP

• Quality of information both internally and externally

• Continual improvement in the effectiveness and efficiency of current services dependent upon

resources; and

• Pooling of an agreed range of procedures between consultants. The Trust will state its

responsibilities for access times and patient information. Similarly patient responsibilities will

be clearly identified

2. Policy scope

2.1 The Business Unit Associate Directors, Managers and Departmental Heads for all business units

are responsible for ensuring that the policy is effectively implemented through the Business

Unit management structure and for reviewing the policy on an annual basis.

2.2 All OPD booking areas and reception areas will carry out periodic audits to ensure compliance

with the Policy. Audit outcomes will be shared at the Data Quality Strategy Meetings.

2.3 The Director of Finance and Information has the responsibility for ensuring that mechanisms

are in place to enable the Trust to collect data accurately and ensuring that systems are

available to do so

2.4 The policy and subsequent amendments will be approved by the Finance and Performance

Committee, Clinical Policy Group for clinican sign off, and the CCG. The policy will also be taken

to a public meeting of the board.

2.5 The Business Unit Associate Directors and Managers along with the Departmental Operational

Managers have the responsibility to ensure that patients are monitored and managed in

accordance with this policy and the procedural guidelines, which underpin the policy

2.6 The clinical management of individual patients on the waiting list is the responsibility of the

clinician in charge of the patient’s care

2.7 GPs/referrers have a responsibility to provide accurate and complete information within

referral letters, use referral templates where available and identify any patient special needs

(including war pensioners). To minimise waits and maximise access, GPs/referrers are

encouraged to make pooled/open referrals to a clinical specialty/sub-specialty.

2.8 Patients are responsible for complying with booking arrangements, attending appointments

and ensuring that the Hospital is informed of any relevant changes in circumstances


Key Principles

As a Trust which promotes diversity and inclusion, both as an employer and service provider, the Trust

will:

• Support staff in providing the best possible quality of care to patients, and to treat patients,

carers, and relatives with dignity and respect, taking into account issues, interpretations and

where possible, the specific needs of people from different race, faiths, cultures, genders and

people with disabilities

• Ensure that staff develop an awareness of policies to promote equality and of the legislative

requirements affecting patient groups

• Review practices and procedures to ensure that services are accessible

• Ensure reasonable adjustments are made where necessary to accommodate the needs of

people from different race, gender and people with disabilities

• Have robust plans developed in collaboration with the CCG and wider health economy to

achieve and maintain access standards/waiting times set by the Department of Health/NHS

Improvement.

• Ensure the management of patients on waiting lists will be equitable and transparent

• Ensure patients are treated in relation to their clinical need and in accordance with their rights

to timely treatment as specified in the NHS Constitution

• Add patients to a waiting list if they are clinically deemed fit to have their operation within the

maximum waiting time guarantee

• Offer patients choice of appointment and admission date within a reasonable time

• Ensure patients of the same clinical priority will be offered dates for treatment in chronological

order with the exception of patients showing flexibility to accept short notice appointments

due to short notice cancellations

• Referral guidelines will continue to be developed alongside systems to feedback on

appropriateness of referrals; for services and those who make referrals

• Have appropriate and effective booking systems across all specialties

• Communication with patients at all stages should be informative, timely, unambiguous and

concise

• All policies, procedures and performance information will be made widely available, including

to the general public (unless there is a specific reason for restricted availability)

• Accurate and up to date information about the outpatient and direct access services provided

by the Trust will be included on the NHS e-Referral Service, Directory of Services (DoS)

• The Trust will offer outpatient appointments to ensure that there is availability for new

referrals to be seen in a timely mannerand to ensure the hospital remains on the “choice”

menu for local referring GPs

National Waiting Times Standards

The Trust is required to achieve the waiting time standards stated in the NHS Constitution and detailed

in the NHS Consitution handbook. For more information on the NHS Constituion and the detail of the

waiting time standards please click on the links below:

https://www.gov.uk/government/publications/the-nhs-constitution-for-england

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/474450/NHS_Consti

tution_Handbook_v2.pdf

Key National access targets associated with the waiting time standards are frequently reviewed and

can be found in the most recent versions of the NHS Single Oversight Framework in the link below:

https://improvement.nhs.uk/resources/single-oversight-framework/


Wherever possible the published National Waiting Times Guidelines on reasonableness for written and

verbal offers of appointments and admission offers will be followed (Appendix 2).

3 Aim of policy

3.1 The length of time a patient waits for hospital treatment is an important quality issue and is a

visible and public indicator of the efficiency of the hospital services provided by the Trust

3.2 The successful management of patients who are waiting for elective treatment is the

responsibility of a number of key individuals and organisations including Clinical Commissiong

Groups, General Practitioners, Hospital Doctors, and Trust Managers. If patients who are

waiting for appointments or treatment are to be managed effectively it is essential for

everyone involved to have a clear understanding of their roles and responsibilities. Patients

also have responsibilities for complying with the booking systems in place.

3.3 This policy defines those roles and responsibilities and establishes good practice guidelines to

assist staff with the effective management of outpatient and inpatient waiting lists. Data

quality is the responsibility of all involved in the care pathway including clinical staff, service

management and administration. The assurance of data quality and coordination of required

improvement actions is the responsibility of the Trust’s Head of Information and Data Quality.

3.4 Data capture, processing and reporting must accurately reflect working practice and be in

accordance with the data principles contained in the Data Protection Act (1998)

3.5 The Trust will manage data quality issues as per the Data Quality Strategy –

http://pandora/docs/policies/DOCUMENTS%20POLICIES/Forms/Information%20Gov

ernance%20Policies.aspx?View={f3c35920-45bf-44e3-873b-

0a73a1f6b3f1}&SortField=LinkFilenameNoMenu&SortDir=Asc

3.6 This policy applies to all waiting lists managed by Gateshead Health NHS Foundation Trust

including inpatient, day case, outpatient, therapies and diagnostic services.

4 Duties - roles and responsibilities

The application and implementation of this policy is the responsibility of all staff and services relating to

patient access managed by Gateshead Health NHS Foundation Trust. All staff involved in the

management of patients’ access to services within the organisation are expected to follow this policy

and associated operating procedures.

Trust Board

Responsible for ensuring there is a robust system of Corporate Governance within the organisation.

Chief Executive

Ultimately responsible for ensuring effective corporate governance within the organisation and has

overall responsibility and accountability for delivering access targets as defined in the NHS plan, NHS

Constitution and NHSI Improvements Single Oversight Framework.

Director of Finance and Information

Will ensure that systems and mechanisms are in place to enable the Trust to capture data accurately

and the appropriate reports are compiled and distributed on a regular basis to facilitate patient care is

delivered within the standards set in the NHS constitution.


Head of Information and team

Produce regular operational reports to monitor waiting times, Patient Tracking Lists (PTL’s) and

dashboards on the delivery of the 18 week Referal to Treatment (RTT), Cancer and Diagnostic waiting

times. Provide support to ensure high data quality, including standard operating procedures and

appropriate training, and provide assurance of the data quality of key indicators.

Systems Manager and System Administrators

Provide initial and ongoing systems and RTT training when changes to guidance or systems occur

ensuring training records are kept up to date. Provide ongoing advice and support staff within Business

units on RTT standards, queries and issues.

Head of Performance and team

Work with business units to manage delivery of access standards and providing analytical support to

do so (e.g. capacity and demand analysis). Provide Trust-wide management of risks to the delivery of

national access standards with regular reporting to CMT and the Board.

Service Line Managers (SLM)

Will be responsible for overseeing the operational management of waiting lists to ensure the principles

outlined in the policy are applied.

Will ensure overall capacity meets inpatient, outpatient, daycase and diagnostic demand within the

constraints of the waiting time targets , service level agreements and contracting levels linked to

consultant job plans

Clinicians

Will be responsible for the timely review or triage of referrals and diagnositic requests received into

the Trust in accordance with the policy timescales (where review is determined appropriate by the

service), ensuring cover arrangements are in place when clinicians are unavailable due to annual leave

commitments.

Support Service Line Managers with capacity and demand planning to ensure all patients are seen

within the agreed local and national access standard waiting times.

Ensure 6 weeks notice is given prior to the cancellation of any outpatient, inpatient and diagnostic

activity and provide alternative dates to reduce impact service delivery.

Ensure completion of clinic outcome slips capturing appropriate RTT status and outpatient procedure

coding.

Waiting List Managers, Adminstration Managers and Secretaries

Each business unit will have members of staff that will have direct involvement or responsiblity in

monitoring and tracking of patients through RTT pathways. This will be determined at speciality level

and SLMs will be responsible for ensuring the staff group provide the following:

• Manage waiting lists and patient pathways in line with waiting time standards, liaising closely

with clinicians, SLMs and the centralised booking team to ensure all patients are accounted for

and booked appropriately, through ongoing review.

• Ensure referral contracts are added within 24 hours of receipt if received directly into

secretary/consultant offices instead of centralised booking team to ensure RTT pathway start

dates are recorded and tracked as soon as possible


• Proactively monitor capacity and demand highlighting capacity shortfalls timely to SLMs and

clinicians to avoid waiting times being compromised and ensure choice of dates are available

within deemed reasonable notice period for type of referral ( ie urgent, routine).

• Validate patient pathways to ensure activity and waiting times are accurate in line with current

national guidance.

• Attend 18week RTT tracking meetings and Data Quality Strategy meetings

Appointments Managers/ administrators

• Will ensure all referrals received into the Referral and Booking Management Centre are

processed timely and appointments booked according to clinical prioirity and/or chronological

order using QM08 reporting tools.

• Will highlight capacity shortfalls to the relevant waiting list manager as soon as apparent using

daily Appointment Slot Issues notification and 2ww reports in the first instance.

Reception staff/ward staff

• Will ensure all patients attending are recorded correctly on PAS systems, using Postive Patient

Safety ID checks.

• Will update outcomes and RTT status where required (or discharge or transfer) on day of

attendance/discharge or within 24 hours if activity takes place out of core working hours.

• Arrange follow up at the direction of the clinician following attendance

GPs and Clinical Commissioning Groups

GPs and Clinical Commission Groups have a pivotal role in ensuring patients are made aware during

their consultation of the likely waiting times for a new outpatient consultation and the need to be

contactable and available when referred. The CCG will be responsible for ensuring robust

communication links are in place to feed back information to GPs.

5 Referral Management

5.1.1 The Trust’s preferred referral route for GP referrals is via the NHS e Referral Service and this is

the mandated route for receipt of all referrals to consultant led services from October 2018 as

outlined in the variation to the NHS Standard Contract 2017-19 6.2A. Where services are not

available, paper referrals (i.e. email, fax, post) should be received by the Referral & Booking

Management Centre. However it is recognised that it may be appropriate for some referrals

to be sent directly to individual business units or services.

5.1.2 A new referral must be made for a patient with an existing condition if the request for futher

consultation is 6 months after the discharge of the original referral unless the patients has

been given a time specific SOS appointment.

5.1.3 Referrals and requests should be triaged within 3 working days of receipt, where possible using

the Windip Workflow module, e-Referral service or Carestream and returned to the Referral &

Booking Management Centre for processing. Business units must work with consultants to

ensure that here are contingency arrangments in place to cover periods of consultant annual

leave, study leave and sickness to prevent delays in triage. Where services are offering Advice

& Guidance through NHS e-Referrals a response must be provided to the referring GP within 5

working days as per contractual agreements.


5.1.4 GP referrals for consultant led services received outside of the NHS e-Referral Service by

services should be sent immediately to the Referral & Booking Management Centre to enable

the appropriate returns process to be initiated as per the variation to the NHS Standard

Contract 2017-19 6.2A. All other referrals received directly into services (consultant offices)

should be date stamped, added to the relevant PAS system and triaged on receipt. Referals

should then be sent electronically using agreed internal mailboxes and/or systems to the

Referral & Booking Management Centre to process where appropriate.

Cancer Referrals

5.1.6 The quality of suspected cancer referrals will be subject to regular review within the clinical

teams with appropriate feedback to the GPs and CCGs.

5.1.7 GP’s will be encouraged to clearly identify referrals which are suspicious of cancer by use of

standardised tumour specific referral proformas recommended by NICE and regional Cancer

Network Groups (Cancer Operational Policy OP90).

5.1.8 Rapid access facilities exist for receiving cancer referrals via the NHS e-Referral service or an

indentified fax or NHS.net account following agreed security protocols. Timely dispatch of

referrals to these faciliites will ensure the fast tracking of appointments as well as avoiding

duplication.

5.1.9 Patients who are referred with suspected cancer must be seen within 14 days of the receipt of

referral and offered 2 dates within this period.

5.1.10 Patients should have a maximum 1-month wait from diagnosis (date of DECISION TO TREAT) to

first definitive treatment for all cancer (31-day target) and a maximum 2-month wait from

urgent GP referral for suspected cancer to first definitive treatment for all cancers (62-day

target). Cancer waiting targets: Guide – Version 8

Tertiary Referrals/ Consultant to Consultant (C2CR)

5.1.11 The Newcastle and Gateshead CCG, C2CR Policy states that to allow choice and treatment to

be provided by the best placed clinician, secondary care clinicians should not refer directly to

internal colleagues except in specific circumstances described below. Instead they should write

to the GP and/or originating referrer to advise on appropriate treatment and further

management. Many conditions can be managed by the skills available in primary care and do

not require secondary care input until these have been completed. Letters back to primary

care may be used as the onward referral letter if they agree that an onward referral is needed

so secondary care teams are asked to include any detail a future specialist may need. The full

policy is available in appendix 3.

6. Appointment Management

6.1.1 All outpatient and diagnostic appointments will be managed on the appropriate patient

administration system and information regarding the status of the appointment recorded at

every opportunity (appointment declined, cancelled and appropriate reasons).

6.1.2 All patients will be booked according to clinical priority. Patients of the same clinical priority

will be offered appointment dates for treatment within chronological order with the exception

of patients showing flexibility to accept short notice and utilisation of appointment slots due to

short notice cancellations.


6.1.3 The Trust will endeavour to contact patients to verbally agree a date and time for those

patients requiring short notice appointments (within 14 days). Attempts will be made over the

course of a working day up until 8pm. If the patient cannot be contacted the appointment will

be booked and a confirmation letter will be generated from the appropriate booking system

providing details how to rebook if the date is inconvenient.

6.1.4 For an written appointment or admission to be deemed reasonable, the patient is to be

offered a date with a minimum of 3 weeks notice. In addition to the 3 weeks notice, for a

verbal appointment or admission offer to be deemed reasonable the patient is to be offered a

minimum of 2 different dates. (DSCN07/2003 guidance Appendix 2). This does not apply to

patients offered short notice appointment due to clinical need.

6.1.5 Referrals generated from HM Prisons will receive a fixed appointment and this will always be

addressed to the Medical Officer of the prison establishment. Security will be informed that a

prisoner will be on site to liaise with Prison Service where required.

6.1.6 Appointments for patient’s requiring interpertering services will receive a fixed appointment

with details of how to rebook, in the preferred language where possible.

6.1.7 All appointment letters will have details of the contact numbers for patients requiring

additional support with their appointment (easy read information etc.,)

6.1.8 In the event of the Trust having short notice availability, this will be offered to patients but

non-acceptance will not compromise the patient’s position in terms of the reasonableness

criteria as stated above.

6.1.9 The NHS e-Referral Service enables patients to fully book directly into a consultant’s outpatient

clinic at the time the decision to refer is made (i.e. at the GP practice). Patients can also book

at a later date via The Appointments Line (TAL) or on-line via the HealthSpace website:

https://www.healthspace.nhs.uk

6.1.10 War pensioners should receive priority treatment, both as Outpatients and Inpatients with the

condition(s) for which the war pension has been given (Appendix 4 )

6.1.11 Military veterans should receive priority access to NHS secondary care for any conditions

which are likely to be related to their service subject to clinically needs of all patients

(Appendix 4)

6.1.12 Patients who fail to respond to an appointment offer within the required timescales (partial

booking processes) will have their referral letter returned to the referring clinician

6.2 Capacity and appointment slot issues (ASIs)

6.2.1 Where patients cannot be allocated an appointment or where slots are no longer available

within the NHS e-Referral Service within the agreed waiting time, due to unavailability of clinic

slots, the appropriate Service Line Managers, Associate Directors and Waiting List manager

will be informed. Patients will be contacted by telephone or sent an acknowledgement letter

(Receipt of Referral) to let them know their request for an appointment has been received by

the trust.

6.2.2 The Referral and Booking Management Centre will send the following reports :

• Daily Appointment Slot Issues reports showing patients unable to directly book


• Daily 2ww Cancer DQ report showing patients referred on the 2ww Cancer pathways who are

unable to directly book due to capacity issues or who have booked beyond 14 days to enable

business units to manage individual patients.

• QM08 report showing all referrals that require an appointment booking (minimum weekly or

as required)

6.3 Patient cancellations (CNA)

6.3.1 If the patient has never been seen and advises they do not wish to progress their pathway,

they will be removed from the relevant waiting list and a clock stop and nullification applied.

The patient will be informed that their consultant and GP will be informed of this.

6.3.2 Patients who cancel their first new appointment should be given an alternative date at the

time of cancellation. Patients originally referred on a 2ww cancer referral must be given a

further appointment within 14 days.

6.3.3 Patients who have cancelled and/or rebooked their appointment more than twice will be

monitored by the Business Unit using the Multiple Consecutive Cancellations Report available in

the Business Intelligence Suite. Having been identified the patient should be subject to a

clinical review within the Business Unit and may be discharged back to the GP if it is clinically

safe to do so or offered a further appointment date.

6.3.4 The appointment confirmation letter will clearly state that should a patient cancel their

appointment twice they may be discharged back to their GP under the process described in

6.3.3.

6.3.5 Patients referred on the 2ww fast track pathway will not be routinely re-appointed following a

second cancellation. An appropriate member of staff nominated by the business unit will

contact the patient to establish the reasons for cancellation. If the patient refuses to keep an

appointment and is unable to co-operate within a reasonable time frame then the

conversation between the Trust and the patient will agree that a return to the GP care is the

most appropriate course of action. A standardised 2ww CNA letter will be generated from the

appropriate booking system and sent to the GP within 48 hours of the decision.

6.3.6 If the patient is unable or refusing to co-operate within a reasonable time frame and this

remains unresolved the patient will be informed by the Business Unit that a letter of non/or

delay appointment will be sent to the advise the GP. A letter from the consultant will inform

the GP of the reason given for a requested delay by the patient. This letter will be sent within

48 hours of contact with the patient for the GP to decide if the patient should be downgraded

from the 2 week wait referral pathway.

6.3.8 If a new or follow up patient informs the Trust that they cannot attend as they have been

admitted as an inpatient to a hospital, the administrator taking the call will inform the relevant

consultant of the circumstances and seek advice as to further action required. Locally agreed

process within the specialities and departments should be in place.

6.4 Attendance at Clinic

6.4.1 On arrival at the appointment, the reception clerk will check to ensure that the details

recorded on the pre-registration form are checked and amendments made on the appropriate

system if required. To ensure compliance with national standards for data collection. If the

patient fails to bring the pre-registration form, Postive Patient ID checks will be made at that

time.


6.4.2 For patients who have identified that they have not lived in the UK for the past 12 months the

Finance Department should be contacted immediately. Further guidance can be found in the

Treatment of Overseas Visitors & Asylum Seekers Policy OP11b.

http://pandora/docs/policies/DOCUMENTS%20POLICIES/Forms/Operational.aspx

6.4.3 Where possible, diagnostic tests should be carried out and results made available before or

during the patient’s attendance at outpatients to reduce the number of visits and

inconvenience caused to patients.

6.4.4 As identified by medical staff, all patients who attend outpatient/endoscopy clinics will have

their outcomes recorded in their health records and on the PAS system.

6.4.5 Clinic outcome slips should be completed by the clinician in clinic identifying status of the RTT

pathway and any outpatient procedures that have been carried out at that attendance. The

reception clerk will then transpose this information into the relevant system to ensure RTT

timescales can be monitored accurately.

6.4.6 Patients attending the Endoscopy unit for procedures will be recorded as inpatient activity in

the Endoscheduler with the exception of Urology patients. These patients will be recorded

initially on PAS as an outpatient, enabling the Trust to continue to receive referrals via NHS e-

Referral service. For the episode to be recorded accurately on the day of the procedure this

will be recorded on PAS as an inpatient episode. The Trust booking teams will remove the

outpatient episode and ensure the inpatient episode is captured. Local SOPs will be in place

within the Endoscopy Unit and the Referral & Booking Management Centre to support this

process.

6.4.7 Arrangements for follow up care will reflect the need to minimise the long-term surveillance

follow-up in preference for an early referral back to primary care; and where

appropriate/suitable the follow-up care will be provided by an alternative professional i.e.

specialist nurses/technical staff.

6.4.8 All follow up patients will be offered choice of appointment and venue at the time of leaving

the clinic if the patient is to return to the Outpatients within 12 weeks or via a partial booking

process where appropriate.

6.4.9 Where it is necessary to issue a patient with an ‘Open’ Out-Patient Follow-up Appointment

(SOS), the patient will be advised of the timescales in order to re-access the system and this

will be noted on the PAS system.

Urgent Inpatient follow up/Discharge Appointments

6.4.10 Wards will liaise with the relevant booking team to agree an appointment date, time and

venue on behalf of the patient.

Routine Inpatient Follow-up/Discharge Appointments

6.4.11 Wards will e-mail requests to relevant booking team with relevant instructions. The booking

team will then contact patient to agree a sutiable appointment.

6.4.12 All suitable patients will be contacted by the Trust Remind/Confirmation service 4-7 days in

advance of their planned appointment and will be asked to confirm their attendance, cancel or

re-arrange their appointment. Patients are given the choice to opt out of this service if they do

not wish to receive a remind/confirmation call. Patients may receive an automated call, SMS

message or agent call depending on service agreements.


6.5 Clinic Outcome Management

6.5.1 It is the responsibility of the medical staff in clinic to ensure that all patients have a clinic

outcomes instruction slip completed at the end of their consultation.

6.5.2 The outcome will indicate attendance, procedures performed in clinic and subsequent actions

with timescales required (ie follow up, diagnostic appt, discharged).

6.5.3 All patients booked into a clinic will have an outcome recorded on PAS against their

attendance.

6.5.4 The information given on the outpatient clinic instruction slip will be recorded on PAS within

24 hours of the patient’s attendance at clinic or as soon as practically possible for domiciliary

clinics.

6.5.5 Written communication in the form of outpatient clinical letters will be sent to the GP/referrer

and patient, from the clinician within 10 working days of the clinic (Copying clinical letters to

patients policy OP18).

6.6 Patients who do not attend an outpatient appointment (DNAs)

Please note, the below processes are the minimum standards that will be expected across services.

Locally some services will have additional steps depending upon clinical pathways. Where this is the

case those services will be responsible for managing this process.

6.6.1 Non-attendees (DNAs) are patients who fail to attend and provide no advanced explanation or

warning.

6.6.2 Appropriate administrative checks should be undertaken to ensure that patient details are

accurate and up to date.

6.6.3 Patients who DNA their 1st new appointment will be invited to contact the Trust to rebook

their appointment within an agreed timeframe (Appendix 5). This excludes cancer and

children’s referrals where relevant legislation overrides this.

6.6.4 If the patient fails to respond in the agreed timeframe the patient will be discharged and

removed from the Outpatient Waiting list. The patient and referring clinician (including patient

GP where they are not the referring clinician) will be sent an explanatory letter .

6.6.5 Patients who DNA a second new appointment, will be discharged and removed from the

Outpatient Waiting list. The patient and referring clinician will be sent an explanatory letter.

The letter will give the GP the option of re-referring to request a further appointment.

6.6.6 Patients who have been referred via the two week wait referral pathways must be

reappointed within two weeks. (Cancer Operational Policy OP90)

6.6.7 Patients referred on a 2ww referral pathway who have multiple DNA’s/cancellations (2 or

more) will be contacted by an appropriate member of staff nominated by the business unit to

identify any factors that may be stopping the patient attending. Another appointment will be

offered if the patient agrees. Patients can be discharged back to the GP after multiple

DNA’s/cancellations (2 or more) if this has been agreed with the patient.


6.6.8 Patients who do not attend a follow up appointment may be offered a further appointment at

the consultant’s discretion. Given the potential child protection issues around the non-

attendance of children, this system will also apply to paediatric patients.

6.6.9 If a patient DNA’s their first appointment and a second appointment is offered, the reported

waiting time will be from the date that the patient agrees the new appointment date (RTT

Rules Suite October 2015).

6.7 Patient Transport

6.7.1 A patient is only eligible for provision of transport (PTS) providing they meet the eligibility

criteria. The Trust is not responsible for the decision making within this process and patients

will have the right to appeal. See PTS Eligibility Criteria –FAQ (Appendix 6)

6.7.2 New and follow up patients or their advocates are required to contact NEAS directly where

they will be assessed to determined if the patient fits the criteria.

6.7.3 When patients have transport booked, the ambulance service must be notified of any

amendments to the patient’s appointment by the patient themselves as indicated in the

patient’s appointment letter.

6.7.4 Any patient who arrives for their clinic appointment by patient transport up to 20 minutes

beyond their planned appointment time will be seen in clinic as soon as possible but made

aware that they may be required to wait until the end of clinic. Patients should not be sent

away without being seen.

6.7.5 Reception staff will ensure NEAS are informed when the patient is ready to be collected.

6.8 Clinic Administration

6.8.1 Clinicians, Associate Directors, or a designated person should review booking rules on an

ongoing basis in line with the Consultant Job Plan to ensure that they remain relevant both to

the needs of clinical practice as well as waiting list management. Any changes to clinic

arrangements must be agreed with the Associate Director.

6.8.2 The rules governing the booking of outpatient appointments should be established by the

clinician responsible for the clinic in consultation with the Associate Director and Service Line

Manager and must ensure that all new patient slots are released to NHS e-Referrals Service for

all consultant led services as per national guidance (CQUIN).

6.9 Clinic Formats

6.9.1 The following booking rule management applies to all clinic formats;

• Set type and number of slots available on each clinic (format)

• Set amount of consultation time available which informs capacity and demand management

• Should take into account the number of clinical staff undertaking the work including clinical

nurse specialists and other professions

• Identify the specialty codes and treatment codes required

• Inclusion in the reminder/confirmation service

6.9.2 Booking rules should reflect appropriate levels of capacity for new and follow-up

consultations. Variances in new to follow up numbers should be monitored by Associate

Directors.


6.9.3 Clinic utilisation and productivity will be regularly monitored by the Associate Directors and

should plan and regularly undertake a systematic analysis of performance against:

• Start/finish times

• Fully booked

• New to follow-up ratio

• Productivity

• DNA and cancellation rates

• Conversion of outcome (demonstrates effectiveness of the clinic by patient outcome),

including conversion rate and discharge

• Information given to patients

6.9.4 Booking rule configuration will be agreed with the Service Line Managers and the Associate

Directors in agreement with each consultant and Business Unit.

6.9.5 Wherever possible, generic booking rules should apply across a specialty.

6.9.6 Booking rules will be routinely reviewed at least on an annual basis with Business Unit staff

with consideration given to discussions related to the Local Delivery Plans

6.9.7 In the event of changes to booking rules being required outside the six weeks notice period,

SLMs and Associate Directors should agree and authorise changes prior to submission to the

Directory of Service Team (DoS). Requests for change will be actioned by administrative staff

on the assumption this authority has already been given.

6.9.8 Requests for new clinics to be set up on the relevant PAS systems should be received by the

Directory of ServiceTeam at least 6 weeks before expected start date or the approximate

waiting time for the service.

6.9.9 In line with NHS e- Referral Service , clinic capacity will be reviewed on a continuous basis and

polling ranges will be published as determined by speciality requirements. Service Line

Managers will be notified on a regular basis of any additional capacity requirements.

6.10 Clinic Changes (Cancellation, reformats, reductions,additions)

6.10.1 For all clinicals sessions held within Medway PAS, the cancelled clinic change proforma

available via the intranet must be fully completed by the relevant consultant secretary or

responsible person for the business unit. For all other PAS systems locally agreed processes

must be followed.

6.10.2 A minimum of six weeks notice of planned clinic cancellations, reformats or reductions must

be given by all clinic staff, together with the reason for such cancellation this include on –call

commitment, audit sessions, or planned annual leave of professional leave.

6.10.3 It is the responsibility of the individual business unit to identify on the proforma where

patients are to be rebooked and also to manage any capacity issues resulting from these

changes.

6.10.4 Any potential breaches caused as a result of clinic amendments will be managed within the

individual business unit.

6.10.5 Only in exceptional circumstances should a patient that has been previously cancelled be

cancelled a second time.


6.10.6 Where an appointment is cancelled by the Trust, an apology will be given to the patient by the

appropriate outpatient support staff on behalf of the consultant (letter). Every effort should

be made to ensure that the patient is offered another date as soon as possible.

6.10.7 For cancellations that are initiated by the Trust, patients should be re-booked as close to their

original appointment date as possible. Service Line Managers will receive monthly

performance dashboards showing cancelled /reduced clinic activity .

6.10.8 When clinics or sessions are cancelled or reinstated or additional waiting list initiatives

requested within 5 days prior to the date of the clinic, secretaries should assist the booking

staff, to contact patients advising them of the changes. Clinics should not be re-instated

without the prior agreement of the appropriate nursing support teams.

6.11 Outpatient Waiting List Validation

6.11.1 All patients will be either fully or partially booked manually or directly booked by the NHS e-

Referral Service, which forms part of the validation process.

6.11.2 As a result of ongoing validation and in accordance with agreed protocols patients will be

removed from the outpatient waiting list in accordance with RTT guidance.

6.11.3 The NHS Constitution mandates that patients are seen within maximum waiting times,

processes have been put into place to investigate any patient queries regarding their right of

access within maximum waiting times. It is the responsibility of all Business units to ensure

these investigations are completed within the agreed timescales and using the investigation

proforma. (appendix 6)

6.12 Management of Inpatient and Daycase Waiting Lists

6.12.1 In line with national and local guidance the Trust is committed to offer all patients a ‘booked

admission’ (Appendix 8). All patients will over time, be offered the opportunity to agree a

booked date for their procedure at the time when a healthcare professional has indicated this

procedure is required, usually at the time of the Outpatient appointment. At this point all

patients should be added to the Waiting List with an agreed booked date.

6.12.2 Patients who receive regular checks or treatments as part of a planned programme of care, are

classified as planned admissions and are not reported on the Waiting List Return but are

recorded on the system.

6.12.3 The computerised waiting list system will be used as the primary tool for waiting list

management to ensure consistency and standardisation of reporting.

6.12.4 The intended management data item on the patient administration system is a crucial part of

the Trust’s overall activity planning process. Only patients who have intended management of

day case will be counted as day cases. Therefore it is very important that there is a reasonable

expectation of no overnight stay the patient is registered as a day case. Patients will be listed

as intended day cases in relation to their procedure.

6.13 Treatment Management

6.13.1 Patients will be registered on Waiting Lists in accordance with National Data Definitions

(Appendix 1).


6.13.2 Clinical priority must be the main determinant of when patients are to be admitted as

daycases or inpatients.

6.13.3 Details of listed patients must be entered onto the computer system within 1 week of the

decision to admit being made.

6.13.4 Each entry must be categorised into clinical priority (urgent, routine or planned) which should

reflect the patient’s need for surgery. Each speciality should have a documented definition for

urgent and routine.

6.13.5 The appropriate departmental staff will add patients to the waiting list on behalf of the

consultant and refer to the PAS training manual prepared by the Information Dept.

6.13.6 Medical staff must make clear to the patient the proposed treatment.

6.13.7 Patients requiring prioir commissioner approval:

As part of NewcastleGateshead CCG value based clinical commissioning an Individual Funding

Request (IFR) policy is in place/development for low clinical value interventions. A list of

specific procedures exists for which IFR is applicable. This is not a fixed list and will be

amended over time as per NICE recommendations and agreed local policy.

Clock stops can only be made to a patients RTT pathway when treatment occurs or a decision

to not treat has been made. No adjustments or clock stops can be made to a pathway whilst a

panel or approval board assesses commissioner approval requests. Patients who require

treatment which must have commissioner approval to commencement must not be

disadvantaged by having their referral returned to primary care. Therefore the referrer to the

Trust must seek prior approval before referring the patient. The approval must accompany the

referral.

In some instances it will not be apparent until the outpatient consultation or on completeion

of diagnostic testing, that the patient requires an excluded procedure. Commissioners should

hold approval panels in line with the 18 week timeframes for any patient referred for

assessment who has already commenced an RTT pathway.

6.13.8 Patients should only be confirmed on the waiting list if:

• There is sound clinical indication for an operative intervention requiring a hospital bed as

either an inpatient or day case, and

• The patient is clinically and socially ready for admission on the day the decision to admit is

made, or

• Should patients contact the trust to communicate periods of unavailability for social reasons

(e.g. holidays, exams), this period should be recorded on PAS.

If the length of the period of unavailability is equal to or greater than a clinically unsafe period

of delay (as indicated in advance by consultants for each specialty), the patient’s pathway will

be reviewed by their consultant. Upon clinical review, the patient’s consultant will indicate one

of the following:

o Clinically safe for the patient to delay - continue progression of pathway. The RTT

clock continues.


o Clinically unsafe length of delay – clinician to contact the patient with a view to

persuading the patient not to delay. The RTT clock continues. In exceptional

circumstances if a patient decides to delay their treatment it may be appropriate to

place the patient under active monitoring (clock stop) if the clinician believes the

delay will have a consequential impact on the patient’s treatment plan or

o Clinically unsafe length of delay – in the patient’s best clinical interests to return

the patient to their GP. The RTT clock stops on the day this is communicated to the

patient and their GP. The patient could also be actively monitored within the trust.

• The patient will agree any provisional date within 24 hours

6.13.9 When the decision is made that a patient requires an inpatient surgical procedure or a day

case procedure, a pre-assessment date should be organised/agreed with them. This pre-

assessment assessment should be within 10 working days of the OP Consultation when the

decision for a procedure is made. At this pre-assessment appointment the following should be

discussed/agreed with the patient and documented:

• Are available to come in at short notice (less than 48 hours) if an unexpected vacancy arises

• Have any special circumstances requiring longer notice than usual for admission (eg, caring for

elderly relative, childcare etc)

• Have any dates when they will not be available for admission, eg, booked holiday, exams etc,

and

• A date will be confirmed with the patient for their surgery

• A TCI date confirmation letter will be sent out by the relevant secretary and will include a

patient information leaflet for that procedure

6.13.10 Patient information leaflets relating to general information about their hospital stay and any

specific information relating to their impending procedure, should be given to the patient at

pre-assessment.

6.13.11 Patients must be placed on the waiting list in chronological order.

6.13.12 Where more than one procedure will be performed at one time by the same surgeon, add first

procedure to the waiting list with additional procedures noted.

6.13.13 Where different surgeons working together will perform more than one procedure at one

time, add patient to the waiting list of the Consultant Surgeon for the priority procedure with

additional procedures noted.

6.13.14 Where patient listed for bilateral procedures, or more than one procedure, but will have initial

surgery on one side at the first admission and subsequent admission for the second side or

procedure:

• Add to the waiting list for the first side/procedure with additional procedures noted

• Put on a planned list for the second side/procedure

• Agree with patient a TCI date for the second side at pre-operative assessment

• Patient will be removed from the waiting list following each procedure

The Peter Smith Surgery Centre

PRE-OPERATIVE ASSESSMENT PROCESS


6.14 Cancellation and Suspension Rules

6.14.1 Patients who self defer for a valid reason should be informed of the likely arrangements for

their future admission. Wherever possible, they should be given a rearranged date at the time

of deferral.

6.14.2 Having been removed from the waiting list following clinical review, if a GP requests that a

patient is placed back onto the waiting list, a new date on the waiting list will be given. Every

effort should be made to ensure that the patient is offered another date according to clinical

priority. Each Business Unit must make local provision to identify how long a patient can wait

depending on specialty and condition.

6.14.3 Theatre lists should not be cancelled within six weeks except through illness or other

unforeseen circumstances. If cancellation is unavoidable notification should be made

according to the procedures described in the Trust Operating Theatre Performance (Scheduled

Sessions) Policy – OP38. Failure to comply will result in an investigation led by the Business

Unit Associate Director or their nominated deputy


http://www.gatesheadhealth.nhs.uk/freedom-of-information/policies-and-

procedures/documents/Live/OP38%20Operating%20Theatre%20Performance%20Dec%20200

8.pdf

6.14.4 Where an operation is postponed by the Trust a verbal explanation together with an apology

will be given to the patient by the appropriate Business Unit support staff on behalf of the

Consultant. The aim must be to offer a new admission date at the time of cancellation

wherever possible. Every effort should be made to ensure that the patient is offered another

date as soon as possible within a maximum wait of a further 28 days.

6.14.6 If an operation is cancelled, for non-clinical reasons on the day of admission, after admission or

on the day of the operation, the patient should be offered an admission date within 28 days of

the cancellation. This should be noted on the waiting list record to ensure that this patient is

not cancelled again. Operations cancelled on the scheduled day for non-medical reasons, form

part of the national reporting standard of Trust’s Performance Indicators.

6.14.7 If patients are cancelled for medical reasons arrangements should be made for the patient to

receive remedial treatment and a review arranged for the patient to attend pre-operative

assessment or the consultant depending on clinical need. The patient’s RTT clock will continue

to tick until a clinical decision is made to not treat. If a decisison is made to not treat, then the

clock will stop and the patient will be referred back to the care of their GP (and/or initial

referrer). Where there is a decision made not to treat, but to retain clinical responsibility for

the patient (for regular outpatient follow-ups etc) then it may be appropriate to start a period

of active monitoring which will also stop the patient’s clock.

6.15 NHS Constitution / Patient Choice

6.15.1 Patients who may potentially wait longer than 18 weeks may be eligible for choice at the

discretion of their commissioning CCG (Appendix 6).

6.15.2 The CCG will be notified of waiting times for each specialty and will identify whether any

patients waiting in excess of 18 weeks should be offered choice at a different provider

organisation.

6.15.3 If choice is not to be offered the patient will maintain their existing place on the waiting list

and continue through the care process. They would then be reported as a breach.

6.15.4 If choice is to be offered the CCG commissioner will be required to identify an alternative

provider (receiving hospital) and inform the Trust of this arrangement.

6.15.5 Any alternative offers made should be for faster treatment than would be possible

in Gateshead Health NHS Foundation Trust (the originating hospital).

6.15.6 For those patients who accept the offer of choice the Trust (as originating hospital) will

provide all appropriate patient details to the receiving hospital, including access to clinical

records in a timely way in order that the receiving hospital can progress treatment.

6.15.7 If a patient chooses an alternative provider and has been clinically accepted by that

provider after a pre-assessment consultation, then the patient is removed from

the originating hospital's waiting list and is entered onto the receiving hospital's waiting list.

6.15.8 Patients are not obliged to accept the offer of an alternative hospital and cannot be

suspended for not accepting such an offer. If the patient does not agree to transfer they


will be made a reasonable offer with their responsible consultant within their original

guarantee date.

7 Training

7.1 To ensure high quality waiting list administration and continual maintenance of data

quality, all staff involved in waiting list management will be trained by the Information

Department to a standard level, tailored to the individual’s responsibilities as part of an

ongoing programme.

7.2 The programme will recognise differences in local administration arrangements while

ensuring consistency in the implementation of this policy. Both new starter and refresher

programmes will be provided on a regular basis. Associate Directors are responsible for

ensuring their staff are fully trained and receive appropriate refresher training

8 Diversity and Inclusion

The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide

services to the public and the way we treat staff reflects their individual needs and does not

unlawfully discriminate against individuals or groups on the grounds of any protected characteristic

(Equality Act 2010). This policy aims to uphold the right of all staff to be treated fairly and

consistently and adopts a human rights approach. This policy has been appropriately assessed.

9 Process(s) for monitoring compliance with the policy

This effectivenss of this policy will be monitored by the indicators below

Standard / process

/ issue

Monitoring and audit

Method By Committee Frequency

End to End

outpatient booking

processes audit

Referrals,

Medway,EMIS, RIS

Booking team

and Reception

teams

Data Quality

Group

Monthly

Cancelled clinic

activity

Cancelled clinic

reports provided by

Information team

Service Line

Managers

Monthly

Cancelled inpatients

activity

Achieving the

Targets

Performance

reports

Service Line

Managers

Waiting List

managers

Weekly

Outpatients waiting

reports

QM08/RTT PTL

provided by

Information team

Waiting List

Managers

Weekly

RTT Standards RTT performance Performance

Team /

Information

Finance &

Performance

Committee

Monthly

Long waiters Performance

monitoring of 40+

week waiters

Performance /

service line

managers

Finance &

Performance

Committee

Weekly


10 Consultation and review

10.1.1 This policy has been reviewed in consultation with the finance and performance committee

on behalf of Trust Board, Clincal Policy Group, and the CCG

11 Policy implementation (including awareness raising)

11.1.1 This policy will be circulated by the Trust Secretary as detailed in OP 27 policy for the

development and authorisation of policies.

11.1.2 The policy will be shared at the DataQuality Strategy Group.

12 References

OP11a Private Patient Policy

OP12 Treatment of Overseas Visitors Policy

OP18 Copy letters correspondence

OP38 Operating Theatre Performance (Scheduled Sessions) Policy – OP38

OP90 Cancer Operational Policy


Appendix 1

Definitions

Inpatients/Daycases

RTT Refers to Consultant-led Referral To Treatment (RTT) waiting times,

which monitor the length of time from referral through to elective

treatment. For further information on RTT waiting times please visit

the below link:

https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-

waiting-times/rtt-guidance/

Active Waiting List Patients awaiting elective admission for treatment who are currently

available i.e. fit, able and ready, to be called for admission

Fully Booked Patients

Booked admissions Patients awaiting elective admission who have been given an

admission date which was arranged by offering the patient choice and

agreed with the patient at the time, or within one working day of the

decision to admit. These patients form part of the active waiting list

Inpatients Patients who require admission to hospital for treatment and are

intended to remain in hospital for at least one night

Day cases Patients who attend hospital for an interventional procedure and are

discharged home within the same day

Decision to Admit (DTA) The date on which a Healthcare Professional confirms that a patient is

fit to be admitted for an procedure. This date should be recorded on

the hospital PAS system. The DTA date is the effective date when the

patient waiting time commences. It is therefore imperative that this

date is accurate and is recorded as the actual date the decision was

made, not the date the patient was added to the list

Waiting List Admission A patient admitted electively from a waiting list not having been given

a date for admission when the decision to admit was made

TCI The date on which patient is due To Come Into hospital for treatment

as daycase or inpatient

SOP Standard operational procedure

EROD Earliest reasonable offer date

Appendix 1 (cont)


Outpatients

Outpatients Patients referred by a General Practitioner, another Healthcare

professional or self referral, for clinical advice or treatment

Partially Booked Patients Where a service operates a partial booking system, the patient will be

added to the partial booking worklist in the appropriate timescales as

instructed by the clinic outcome slip. A letter is sent to the patient at

an agreed timescale (service specific) in advance of the expected due

date of appointment, asking the patient to telephone the hospital. An

appointment is agreed with the patient upon contacting the hospital.

A confirmation letter is sent to the patient. If the patient does not

contact the hospital a reminder letter is sent. If the patient fails to

contact the hospital the patient is removed from the partial booking

worklist and the referring clinician informed.

NHS e-Referral Service Is a national system that allows referrers and patients to search for the

provider of choice and enables and electronic booking of date and time

of first consultant outpatient clinic.

Directly Bookable The patient will be able to NHS e-Referral Service to book an an

appointment with their chosen provider following a referral via their

GP. These appointments can be made directly in the GP practice, via

the National Appointments Line (TAL) or by the patient via NHS

Choices website.

Date of Receipt of Referral The date on which a hospital received a referral letter from a GP or

other referrer (DRR). The waiting time for outpatients is calculated

from this date. The waiting time for NHS e-Referral Service patients is

calculated from the date of the Unique Booking Reference Number

(UBRN) conversion date i.e., the date on which the patient actually

booked their appointment. In the event of capacity issues within NHS

e-Referral Service the GP will add the patient to the Defer to Provider

worklist . The DDR is calculated from the date the patient appears on

this worklist. NB. For onward referrals from MSK Cats services via NHS

e-Referral Service where 1st definitive treatment has not been given

the pathway start date (date the original referral was received into the

MSK Cats service) must also be recorded

List (Pending) on hold lists A holding list of patients waiting for an outpatient appointment. The

process ensures patients are seen in chronological order and have the

opportunity to choose a convenient date

Directory of Services (DoS) The Directory of Service (DoS) is the core of the NHS e-Referral

application. It holds information that describes the types of services

the Trust offers, including service specific referral criteria and guidance

which enables the referring clinician to search for appropriate services

to refer patients. The DoS also provides patients with a list of suitable

providers for their treatment.

Appendix 1 (cont.)


SNOMED Is the common language which will eventually be used by all

Systematised Nonmeclature computers across the NHS. These terms

are loaded each Directory of Service published in NHS e-Referrals to

enable referrers to search for the appropriate service without the need

to use clinic types or specialities

Appointment Slot Issue (ASI) Is the term given when inadequate capacity is available for direct

booking via the NHS e-Referral service.

UBRN Unique booking referernce number is allocated to a referral by the

NHS e-Referral Service at the time the GP raises a referral in the

system.

PAS Trust patient administration systems (Medway/ EMIS/ Carestream RIS/

Endosoft etc)

SOS See on request, given to patients who do not require specific follow up

but have the opporturnity to arrange an appointment if the need arises

within a specific time frame from their last appointment

Inpatients, Day Cases & Outpatients

Planned Admissions Patients who are to be admitted as part of a planned sequence of

treatment or investigation. The patient has been given a date, or

approximate date at the time a decision to admit was made. These

patients are not counted as part of the active waiting list

Did Not Attend (DNA) Patients who have been informed of their date of admission or pre-

assessment (inpatients/day cases) or appointment date (outpatients)

and who without notifying the hospital did not attend for the

admission/ outpatient appointment

Cancellation When a patient cancels an appointment (Cancelled by Patient – CBP)

or the Hospital cancels an appointment (Cancelled by Hospital – CBH)

Self-deferrals Patients who, on receipt of reasonable offer(s) of admission, notify the

hospital that they are unable to come in

Duty of Care The duty of care rests with the referrer until such time as the referral is

accepted by the provider or a Clinical Assessment Service

Tertiary Referrals Tertiary Referrals are those referrals between Healthcare professionals

from outside of the Trust

Cons to Cons referrals Are referrals between healthcare profession within the Trust.


Appendix 1 (cont.)

Inter-Provider Transfer A form used to accompany patients’ transferred to Gatehead Health

NHS Foundation Trust from another provider showing RTT status

Minimum Data Set Form Used when patients are referred internally between clinicians

identifying continuation of pathway or new condition

Private Patients Private patients who have made separate arrangements to be treated

by a practitioner may be charged professional fees by the Consultant /

Health Care Professional (OP11a Private Patient Policy)

http://www.gatesheadhealth.nhs.uk/freedom-of-information/policies-

and-procedures/documents/Live/OP11%20Private%20Patients.pdf

Overseas visitors Persons, who are not normally resident in the UK, may be called upon

to pay the cost of their hospital treatment unless they meet one of the

exemptions from charges (OP11b Treatment of Overseas visitors &

Asylum seekers policy)

http://pandora/docs/policies/DOCUMENTS%20POLICIES/Forms/Opera

tional.aspx

Breach date A pathway will become a breach on the day after the breach date if the

patient has not received the appropriate appointment/diagnostic test

or treatment

PTL Patient tracking list

CCG Clinical Commission Group


Appendix 2

National Waiting Times Guidelines – DSCN 07/2003


Appendix 2 (cont.d..)

National Waiting Times Guidelines – DSCN 07/2003 (Page 2)


Appendix 2 (cont.d…)



Appendix 3

Consultant to Consultant Referral – Out Patient Guideline

1. Introduction

Patients want high quality care. With greater specialisation there is a growing need for primary and

secondary/tertiary care to work effectively together to ensure that this is delivered. The General

Practitioner has a pivotal role as a navigator for individual patients care.

Newcastle Gateshead CCG would like to ensure that Consultant to Consultant referrals are minimised to

the specific areas detailed in this guidance. General Practitioners are Expert Generalists and referrals for

conditions not related to the original problem should be directed back to them.

C2C referral activity will be monitored in line with the contract agreement and will only be funded in line

with the agreements in the contract.

2. Revised C2CR Protocol

2.1 Internal C2C Referrals

Whilst it is recognised that C2CR make up the majority of internal referrals this protocol also applies to

referrals from, and between, other healthcare professionals.

To allow choice and treatment to be provided by the best placed clinician, secondary care clinicians should

not refer directly to internal colleagues except in specific circumstances described below. Instead they

should write to the GP and/or originating referrer to advise on appropriate treatment and further

management. Many conditions can be managed by the skills available in primary care and do not require

secondary care input until these have been completed. Letters back to primary care may be used as the

onward referral letter if they agree that an onward referral is needed so secondary care teams are asked to

include any detail a future specialist may need.

2.2 Internal C2CR referrals will only be allowed in exceptional cases, as follows:

i. Where the referral is clinically urgent (2 week wait), for example:

• Suspected cancer.

• Where any short delay might be life threatening

ii Related to the original issue for which the patient was referred

The C2C referral arises from a pre-assessment clinic visit and the referral is required to facilitate the

procedure for which the patient was referred.

iii Referrals from A&E where failure to make an OPD referral will result in clinical deterioration leading to

either admission or re attendance at A&E in the short term i.e. next 7 days. NB: Where relevant

Primary/Community based services exist these should be considered as the first destination to manage

the patient’s condition e.g. community based musculo-skeletal clinics or COPD service.

iv Where after appropriate assessment and investigation, the problem turns out to be due to a condition,

the management of which is outside the area of expertise of the initial consultant, then it would be in

the patient’s best interest and expeditious for a referral to another consultant.

V Where it is in the patient’s interest to be referred to one or more other consultants within the MDT e.g.

patients suffering from chronic complex conditions may need involvement from a range of clinicians


who form a Multi-Disciplinary Team. However ongoing follow up by multiple consultants should, so far

as practicable, be minimized.

vi Referrals to “Hot Clinics” such as first fit clinic and fracture clinic from A&E (and to orthopaedics from

the fracture clinic).

• Acute Providers retain discretion to deliver any referral falling within the following 3 categories within a

timeframe relevant to maintain clinical momentum in the patient pathway

vii Where sub-acute true “tertiary” referral is needed relating to the condition or symptoms that triggered

the original referral.

viii Where referrals form part of local priorities including Quality Indicators such a

CQUIN.

viiii Where it is necessary, as part of the investigation of the presenting problem, to perform specialist

investigations (e.g. endoscopy) then a referral to a consultant with the necessary skills should be made

ix The C2C referral arises from a pre-assessment clinic visit and the referral is required to facilitate the

procedure for which the patient was referred.

All other recommendations that Consultants might wish to make for onward referral must be forwarded to

the patients GP and/or originating referrer for their review. C

Commissioners, GPs and secondary care providers, want to ensure that patients are seen by the most

appropriate clinician to deal with their problem whilst also ensuring that it minimises:

• Clinical risk

• Delays in clinically urgent cases;

• Patient inconvenience;

Patients with suspected cancer or other urgent problems must not have their care or diagnosis delayed.

Shifting the responsibility and accountability for Consultant referral from acute Trusts back to the GP,

except in the circumstances outlined above, will ensure that the long term management of a patient

remains within the oversight of the registered practice and decisions on patient care will be made jointly

between patient and GP and where appropriate involve secondary and tertiary care clinicians.

2.3 No other internal C2C referrals will be funded by the CCG and patients must be referred back to the

GP and/or originating referrer where the intended C2CR referral is:

i. For a clinical condition that is not directly related to the reason for the original referral or is an

incidental clinical finding. E.g. a dermatological condition in a patient referred for a surgical reason.

If investigations of the presenting problem turn up some incidental abnormal finding or condition that

would normally be managed in primary care (e.g. an elevated blood sugar in a patient who is well and who

has no symptoms of diabetes) the abnormal result should be communicated to the GP. Onward referral

should not be made. It is important that the practice is contacted urgently with a clear reason why tests

were done and which issues the practice is expected to address.

ii. Made following an attendance at A&E for a condition that is not clinically urgent

iii. Referrals to Adult pain clinics can only be made by primary care. Patients with ongoing pain issues

should be referred back to the GP for further planning of care to ensure all the initial parts of the

pain pathway have been completed before referral is made.


iv. The referral does not fall into any of the exceptional categories above.

2.4 Original referral sent to the wrong clinical team

Where the original referral was to the wrong clinical team - these referrals should be referred onwards to

the appropriate internal Speciality clinical team. This is consistent with the Choose and Book policy on

redirected referrals. Commissioners will work with providers and referrers to ensure that the DOS is up to

date, that triage takes place by providers and that referrers ensure referrals are directed to the correct

clinic.

2.5 Patients admitted as an emergency with a problem already under review

If a patient is admitted as an emergency with a problem that is already being reviewed in OPD and a clinical

follow up is required, then the on call consultant for that admission should if necessary refer the patient

back to the “usual” consultant as a “REVIEW at OPD” if the patient has been seen within the last 6 months

2.6 Referring back to the GP

When referring the patient back to the GP for follow up related to any of the above non-urgent reasons the

responsibility for the patient’s on-going clinical care passes back to the GP. The patient must be informed

that they will need to contact their GP. The Consultant/Health Professional will write back to the GP –

ensuring the letter is received within 10 days in 2017/18 as per contract and 7 days in 18/9- outlining

clinical assessment and management so far and provide advice on potential treatment options and/or

reasons why onward referral to an appropriate speciality is considered necessary. Communication with the

patient will be key. Patients should be informed that they are being referred back to their General

Practitioner for discussion on further management of the problem, rather than that their GP will arrange a

referral. Letters to GP’s must clearly state recommendations for the GP and that the patient has been

requested to make contact to discuss the issue of concern.

3. Guiding Principles: Consultant to consultant referrals

3.1 Commissioner quality expectations

• Patient care is not compromised

• Patients continue to receive timely care.

• Changes do not hinder the 18 week target

• That the changes are cost effective.

• Changes do not encourage perverse clinical practice to circumvent C2CR policy

• That Junior medial staff are made aware of the policy and these principles. It is recommended

that they would form part of their induction.

• Triage of referrals is performed to ensure that patients are seen by the appropriate clinical team

3.2 Referral criteria outcomes

• Consultant to consultant referrals across specialties no longer take place for non-urgent and non-

related conditions.


3.3 Relevant referral standards to be met where they exist C2CR Protocol

• Consultant to consultant referrals in line with best practice for example NICE / Map of Medicine /

Network pathways

3.4 Audit processes used to track changes

• Formal audit will be carried out as part of the contract monitoring processes

We are keen to avoid unintended consequences of this policy. If you have suggestions to improve

this please contact me:

Dr Steve Kirk, Clinical Director, Newcastle


Appendix 4

Priority Treatment for War Pensioners and Military Veterans

Health Service Guidelines

HSG(97)31

Date: 18 June 1997

PRIORITY TREATMENT FOR WAR PENSlONERS

Executive Summary

These guidelines advise health authorities and trusts of an extension of the definition of the term “war

pensioner” to cover people who were injured or disabled as a result of service in the armed forces either

before the First World War or between 1 October 1921 and 2 September 1939, the “inter-war years”.

Health authorities and trusts are also reminded of the arrangements for priority treatment of war

pensioners.

Action

Chief Executives of health authorities and trusts should ensure that general practitioners and relevant

hospital staff are advised of the new definition and are reminded of the arrangements for the priority

treatment of war pensioners.

Background

A war pensioner has previously been classified as someone who has a pension or who had a gratuity for

disablement caused by armed service during the 1914-18 and 1939-45 wars and service since 1945. This

includes merchant seamen and civilians who receive pensions for wartime injuries.

The term “war pensioner” has now been extended to cover people who were injured or disabled as a result

of service in the armed forces either before the First World War or between 1 October 1921 and 2

September 1939, the “inter-war years”.

In 1953 hospitals run by the Ministry of Pensions for the treatment of war pensioners were transferred to

the NHS. The Government gave an undertaking that there would be priority examination and treatment for

war pensioners in NHS hospitals for the condition or conditions for which the war pensioners received a

pension or gratuity.

NHS hospitals should give priority to war pensioners, both as out-patients and in-patients, for examination

or treatment which relates to the condition or conditions for which they receive a pension or received a

gratuity (unless there is an emergency case or another case demands clinical priority). Priority should not

be given for unrelated conditions.

Referrals for treatment should make it clear that the patient is a war pensioner and requires treatment for

the condition or conditions for which the war pensioner was given a pension or gratuity.

War pensioners can use the NHS complaints system to resolve any alleged breakdowns in the

arrangements for priority treatment. This includes ultimately asking the Health Service Commissioner to

investigate their case

Cancelled Circular

HSG(94)28 is cancelled

Appendix 4 (Cont.d…)


Addressees

For action:

Chief Executives of Health Authorities

Chief Executives of NHS Trusts

For information:

Regional Directors

From

NHS Executive

Health Services Directorate

Wellington House

135-155 Waterloo Road

London SEA U

Tel: 0171-9724833

Further copies of this document are available from:

Department of Health

PO Box 410

Wetherby

LS23 7LL

Fax 01937 845 381

or by calling the NHS Responseline on 0541 555 455

© Crown copyright 1997

10901 HCD 1300 1P JUN97 SA (0)



From the Chief Medical Officer, Sir Liam Donaldson

9th

February 2010 Richmond House

79 Whitehall

To: GPs London

SW1A 2NS

Copies: Chief Executives SHAs, CCGs, NHS acute

and mental health trusts and NHS Foundation trusts Tel: +44 (0)20 7210 5150-4

Fax: +44 (0)20 7210 5407

[email protected]

www.dh.gov.uk/cmo

Gateway Reference 13406

Dear Colleague

ACCESS TO HEALTH SERVICES FOR MILITARY VETERANS – PRIORITY TREATMENT

The purpose of this letter is to advise you of the guidance in place to ensure that military veterans receive

priority access to NHS secondary care for any conditions which are likely to be related to their service,

subject to the clinical needs of all patients.

Action

GPs are asked, when making referrals relating to a military veteran for diagnosis or treatment, where they

are aware of the patient's veteran status, to record that status as part of the referral. If the patient does

not want the GP to record their veteran status the information should not be included. If GPs consider that

priority treatment might be appropriate because the condition to which the referral relates is likely to be

related to the patient's time in the services, GPs are asked to include details in the referral.

Background

The ongoing deployment of UK armed forces means it is now more important than ever that the NHS works

closely with military services to ensure that the health needs of the Armed Forces, their families and

veterans are appropriately met. In particular, it will be important to provide priority treatment, including

appropriate mental health treatment, for veterans with conditions related to their service, subject to the

clinical needs of others.

There are about 5 million veterans in England (a veteran is defined as someone who has served at least one

day in the UK Armed Forces). For the vast majority of veterans their time in the service will have been a

positive experience but some will leave with medical conditions resulting from their time in service.



In December 2007, the Chief Executive of the NHS wrote to Chief Executives of Strategic Health Authorities,

Primary Care Trusts, NHS Foundation Trusts and NHS acute and mental health trusts (Gateway reference

9222) informing them that the extension of priority treatment arrangements for veterans would commence

from 1st

January 2008, and asked that GPs and others were made aware of this.

Successive NHS Operating Frameworks, including that published in December 2009, have continued to

reiterate the requirement for CCGs to ensure the needs of this community are appropriately met. Despite

this, research by the Royal British Legion has shown that few GPs are acting on these provisions. Given the

ongoing nature of UK Armed Forces involvement in Afghanistan and the current and future needs of the

veteran population, it is important that access to priority treatment is identified where appropriate.

Next Steps

Where the patient is content for their veteran status to be included, GPs are asked to clearly state this

when drafting referral letters including, in your clinical opinion, that the condition may be related to

military service.

When utilising Choose and Book, GPs are asked to refer normally and select the correct appointment

priority based upon the patients medical condition (routine / urgent or 2 week wait) including veteran

details in the referral letter (refer: http://www.chooseandbook.nhs.uk/staff/communications/fact/Armed-

Forces.pdf)

Where secondary care clinicians agree that a veteran’s condition is likely to be service-related, they are

asked to prioritise veterans over other patients with the same level of clinical need. However, and as set

out in David Nicholson’s letter of December 2007, it remains the case that veterans should not be given

priority over other patients with more urgent clinical needs.

In order to ensure continuity of care, it is anticipated Defence Medical Services will commence direct

transfer of medical records to GPs when individuals leave the Armed Forces. GPs and practice nurses are

asked to include as a minimum the “History Relating to Military Service” code (Read: Code Xa8Da or

SNoMed CT: 302121005) against all known veterans within the practice.

If you have any queries about this letter, please contact: Department of

[email protected]

Yours sincerely

Sir Liam Donaldson KB

Chief Medical Officer


Appendix 5

DNA process

This process is not intended to remove clinical decision making


Appendix 6

NHS Constitution - Initial Contact Information

Date: Time:

Patient

Details

Full Name: dob:

Address:

Unit Number: NHS Number:

Callers Details Name:

(if not the patient): Relationship to patient:

Speciality: Consultant:

18 week target 2 week target

Preferred Contact Home:

Details: Mobile:

Work:

e-mail:

Preferred time for call

Reason for Call:

Action Taken:

By Whom – Name / Title:

Date: Time:

FORWARD TO BOTH SPECIALITY WAITING LIST MANAGER AND DISTRIBUTION LIST

WITHIN ONE HOUR OF RECEIPT


Appendix 6 (cont.d…)

TO BE COMPLETED WITHIN 24 HOURS OF RECEIPT OF ISSUE

NHS Constitution - Speciality Investigation

Patient Time Line (to include target breach date):

YES NO

Has the patient met the specified targets?

YES NO

Can a sooner appointment be made?

Discussion with Patient:

Date: Time:

YES NO

Outcome:

Does patient require alternative provider?

YES NO

Is the patient willing to travel?

Action Taken Following Discussion with Patient:

Instructions to CCG (to include type of appointment required, eg: OPD, test, surgery)

Form completed by

(name)

Title:

Date: Time:

E-MAIL PROFORMA ONTO DISTRIBUTION LIST

FORWARD ON DETAILS TO CCG



NHS Constitution - CCG Communication Form

YES NO

Is an alternative provider being requested?

Details of Alternative Provider Sort:

Final Outcome:

Form completed by

(name)

Title:

Date: Time:

E-MAIL PROFORMA BACK TO BOTH SENDER AND DISTRIBUTION LIST


Appendix 7

Patient Transport Service Eligibility Criteria - Frequently Asked Questions

From the 20th

October 2014 all new planned Patient Transport Service (PTS) bookings became subject to an

eligibility assessment; this currently excludes bookings made in Sunderland and North Tyneside. This takes

the form of a small number of questions being asked at the time of booking. The aim of this is to help

ensure that only those patients who genuinely need patient transport receive it.

The aim of this leaflet is to answer some of the questions that we have been asked since the criteria was

implemented. We aim to circulate regular updates as the assessment process is refined and embedded.

I have had problems contacting my booking provider – is there a risk of a delay if I am trying to book an

Urgent Ambulance?

No, urgent ambulances are booked through a separate telephone number and a different staff group.

Please make sure that you are ringing the correct number for the service you require. Please do not use the

urgent line to attempt to either book transport or notify NEAS that a patient is ready for collection as you

will be directed back to the main booking number.

Questions for Hospital Staff

Are hospital discharges affected?

If a patient is being discharged from an inpatient stay then they will not be subject to the eligibility

assessment. If the patient is being treated as an outpatient or a day case and already had a return journey

booked then you will not need to go through the criteria again. If you are booking follow up outpatient

appointments, these will be subject to assessment. If the patient already had transport booked but this had

to be cancelled and a new booking is being made, the booking will be subject to assessment.

Are inter-hospital transfers for specialist appointments subject to an eligibility assessment?

No, all inter-hospital transfers will not be subject to an eligibility assessment.

Do the criteria affect ‘Ringing Ready’? (Informing NEAS that a patient has completed their appointment

or treatment and is ready for collection)

No, as the patient has already been assessed as eligible for the journey at the time it was originally booked.

However, the contact centre is currently experiencing a high volume of calls; therefore ring ready calls may

take some time to get through and NEAS is strongly recommending that the online system be used where

possible to notify when a patient is ready for collection.

If your department does not have access to the online booking or if you are having any difficulties using the

system please contact the NEAS Customer Care Team on:

Tees/South Durham areas - 07969 193544

North Durham/South Tyne - 07817 812511

North Tyne/Northumberland - 07973 970994

Alternatively, email: [email protected]

If a patient is unhappy with the outcome of the assessment what do I do?

If a patient has been determined as ineligible by the assessment but either the patient disagrees with this

or wishes to make a complaint, you can refer them to the Patient Advice and Liaison Service (PALS). Further

information on this can be found in the PTS Appeals Process Leaflet that accompanies this FAQ document.



Has the criteria gone live across the whole region?

No, the criteria will be live across the region by the end of 2014. Sunderland and North Tyneside have not

yet implemented the eligibility assessment. The planned dates for implementation in these areas are as

follows:

Sunderland: 3rd

November 2014

North Tyneside: 1st

December 2014

Final confirmation of these dates will be made as each date approaches.

Are any patients or medical treatments/conditions exempt from the criteria?

Yes, for the present time all bookings that are to transport patients to receive oncology or renal dialysis

treatment are exempt from any eligibility assessment. This decision may be reviewed in due course.

Questions for Transport Bookers

If I book a return journey will the assessment take place twice?

Maybe, if a patient is assessed as being eligible for transport to an appointment, then they will

automatically be eligible for the return journey. However, if a patient is not eligible for transport to an

appointment, they may still qualify for transport back depending upon the treatment received. An example

would be a patient who can use public transport but is attending for an ophthalmic procedure and will not

be able to make their own way home independently. This patient would be expected to make their own

way to the appointment but would qualify for transport back, if there were friends or family able to assist

them.

If I make multiple bookings at one time for the same patient, do I have to go through the criteria for each

booking?

Currently yes, however we are looking to develop the system to avoid this.

If I am amending an existing regular booking will it become subject to an eligibility assessment?

Any changes to a booking that require a new booking to be created on the system will automatically be

subject to the eligibility assessment. This applies whether the regular booking was set up prior to or after

the implementation date.

I am trying to use the online booking portal to make an out of area booking, why can I not do this?

Out of area bookings are a more complicated process and require assessment and authorisation from the

CCG. You will need to contact your booking provider by telephone to make this type of booking.


Appendix 8

Trust Procedures for Inpatient and Day Case Waiting Lists

Consultant decides to admit for

surgery/procedure

POA not required

NP advises secretary to

send patient info leaflet

with TCI confirmation

letter

Consultant offers date to

patient using diary/paper

record of next available theatre

slot

Medical questionnaire

completed by patient (includes

any time patient next available

in next 10 working days)

Notes and medical

questionnaire to Pre-operative

Assessment

NP decides if POA required and

decides on most appropriate

slot, i.e. anaesthetic appt etc.,

within 10 working days

POA clerk puts patient onto

PAS and ends confirmation

letter


Eligibility Criteria

Patient Clinical Needs Banding (excludes First Response)

Category Clinical Needs of Patient

A - Life-threatening call

(999 call)

Paramedic / Technician Crew Arrangements made by

contacting Accident &

Emergency Control

B - Serious (999 call) Paramedic / Technician Crew

C - Neither life threatening nor

serious (999 call)

( Paramedic crew )

or

( Technician crew )

or

( Support Tier crew )

D - Urgent Journey (Doctors Urgent

callE - Non-urgent A&E needs A&E

crew but not time critical. (Doctors

urgent call)

F - Short notice, non-emergency

journey for specialist referrals and

admissions ie oncology/plastics/eyes

Double crew – may need oxygen,

2 staff, manual handling /

mobility skills

NB Patients on drips and infusion

pumps must have a nurse escort,

otherwise A&E

Arrangements made by

contacting Patient Transport

Service Control and or

Planning section. Capacity

depends on availability

G - Non-emergency journeys

requiring ��

Double crew – may need oxygen,

2 staff, manual handling /

mobility skills

NB Patients on drips and infusion

pumps must have a nurse escort

H - Non-emergency journey requiring

��

Single crew with manual

handling/mobility skills

I - Non-emergency journey requiring

��

Unskilled single crew or

Ambulance Car Service


Waiting lists should be kept up to date by identified Trust staff. There is a need to ensure that patients are

listed promptly and that the list does not contain patients who no longer need their operations at the

hospital.

Details of listed patients must be entered onto the computer system within one week of the decision to

admit being made. Failure to do this will lead to incorrect assessment of waiting list size when the monthly

census is taken.

a) Adding Patients to the Waiting List

When a patient opts not to accept a reasonable available admission date (21 days notice) or

requests admission not to take place prior to a given date, due to non-medical personal or social

reasons, their case should be reviewed individually. Other than in extenuating circumstances, the

patient should be referred back to the GP, for appropriate care management, or suspended from

the waiting list until they are willing to be admitted. Both patient and GP to be informed in writing

of the action. Exceptions require the authorisation of the appropriate Associate Director.

b) Selection of Patients for Admission

The appropriate directorate staff will create the TCI list (using standard format) in order to provide

written confirmation of elective admission (TCI letter). The TCI letter should contain the following

core details:

Patient’s name

Date letter sent to patient

Date and time of admission

Arrangements for transport

Where to report on arrival

Response required from the patient

Named contact for queries relating to admission

Reference to check bed is available on day of admission

Reasons for checking bed availability

Information about the planned treatment

They should be sent out in the name of the Consultant

If letters are not sent out on the day or preparation from the PAS system, they must be double

checked to ensure that the patient is not already in hospital or has not died in the interim. Letters

should clearly state what action the patient must take in order to confirm or decline their offer of

admission. Request a response either by telephone (to a named individual) or on an enclosed

response slip (with a business reply envelope)

The process of selecting patients for admission and subsequent treatment is a complex activity. It

entails balancing the needs and priorities of the patient and Purchaser against the available

resources of theatre time and staffed beds


War Pensioners should receive priority treatment if the condition is directly attributable to injuries sustained

during the war periods.

Patients who move house:

OPTION

Consideration should be given if any account can be taken of the previous wait at the other hospital. If

possible the earlier decision to admit date will be observed

c) Transfer between Providers

� Transfers to alternative providers must always be with the consent of the patient, their GP and the

transferring Consultant*. If a patient does not wish to be transferred, the original provider must ensure the

patient is admitted for treatment in compliance with the Patient’s Charter

Purchaser offers patient treatment at another hospital

Patient and GP permission sought and obtained

Consultant at second provider accepts patient on Waiting List with the original date on the Waiting List

Patient removed from Waiting List at original provider

If the patient and/or GP declines offer the patient remains on the Waiting List of the original provider

*EL(95)57 The Transfer of Patients to Shorter Waiting Lists applies

Patient moves house

A

Remain on Waiting List of

original hospital

B

Choose to transfer to new hospital

Normal guarantee applies Original guarantee no longer applies

Guarantee applies from date new Consultant put patient on Waiting List


Review and Validation

� Review will be undertaken by the appropriate Divisional support staff on a weekly basis using standard

PAS reports generated and printed locally

� The Associate Director will review their waiting lists at least once a month to ensure that details are

accurate and up to date reporting mechanisms to be agreed

� The Associate Director in liaison with the Information Department will validate each waiting list at least

twice per year by sending waiting list review letters generated using PAS. This exercise will be conducted in

line with national best practice, and the Trust will continuously review its processes

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