PATIENT ACCESS POLICY

Transcription

1 PATIENT ACCESS POLICY Page 1 of 44 Printed Copies may become out of date. Check online to ensure you have

2 CONTENTS AND PAGE NUMBERS Patient Access Policy... 1 Contents And page numbers... 2 EXECUTIVE SUMMARY/ INTRODUCTION... 4 purpose and scope... 4 duties and responsibilities... 5 Chief Operating Officer... 5 Director of Finance... 6 Managers... 6 Consultants... 6 Information Management & Technology (I M &T)... 6 Medical Records... 7 Choose and Book Directory of Services... 7 Appointments/Waiting List Coordinators... 7 Wards & Departments... 7 Theatre/Ward Managers... 7 Pre operative Staff... 7 Medical Secretaries... 7 Referrers (e.g. GPs, Dentists, Opticians) and Clinical Commissioning Groups... 8 MANAGING WAITING LISTS, SCHEDULING AND BOOKING... 8 Patient Administration System... 9 Booking systems... 9 Referrals/Requests... 9 Prior Approval Scheme(s)... 9 Special requirements Referrals from Other NHS Organisations Outside of England See Appendix 6 for additional information Consultant to Consultant Referrals Inappropriate referrals/requests Mismatch of Consultant Interest and Patient Needs Insufficient/illegible Clinical Information Down Grading of a referral Determining Priority of a Referral Equality and Diversity / Special Requirements Timeliness of and Adding a Patient to the Waiting List week pathways Elective Admissions Patient Transfers Patients listed for Bilateral procedures or for more than one procedure Private Patients Reasonable Notice Cancellations Re-instatement on the waiting list Re-instatements for Clinical Reasons Re-instatement following an Inappropriate Removal DNAs (Did not Attend) Active Monitoring Exceptions for removals from the waiting list Recording Clinical Outcomes ( Cashing-up ) Clinic Template Changes Retrieval of Medical Records Patient Correspondence Management Information OUTPATIENT BOOKING AND SCHEDULING Introduction Page 2 of 44 Printed Copies may become out of date. Check online to ensure you have

3 Choose and Book Paper/Other referrals letters Follow-up Appointments Diagnostic Intervention Follow-up Overbooking of Clinic Templates New to Review Ratios Private Utilisation of OPD inpatient/daycase WAITING LISTS Introduction Selecting patients for admission Categorising Patients on the Waiting List Waiting list Management Pre-op Assessment Service Patient Transfers DIAGNOSTIC (non endoscopy) WAITING LIST Introduction Diagnostic Procedures Imaging Referrals Data Definitions Booking system Potential Breeches Launch Plan / Policy Implementation Key Staff Groups Medical Records and OP managers are responsible for providing: Senior Managers are responsible for Medical Staff are responsible for Training/Update Sessions Patient Access Procedures Review and Monitoring Policy Reviews Effectiveness Reviews Monitoring Achievement of Standards in the Patient Access Policy Monitoring of the DOCUMENTED PROCESS Patient Access Policy Sources/ References Glossary of Terms DEFINITIONS/ABBREVIATIONS ABBREVIATIONS ASSOCIATED DOCUMENTS APPENDIX 1 KEY PERFORMANCE TARGETS APPENDIX 2 sop FOR MANAGING PATIENTS ON A SUSPENDED WAITING LIST APPENDIX 3 sop FOR MANAGING PATIENTS ON A PLANNED WAITING LIST APPENDIX 4 Protocol for Referrals from Outpatients Clinics To Other Specialties / Trusts 40 APPENDIX 5 Referrals from Other NHS ORganisations outside of England EQUALITY IMPACT ASSESSMENT Document Information Box (Completed by AUTHORISED DIVISIONAL/CORPORATE SERVICE Librarian) Page 3 of 44 Printed Copies may become out of date. Check online to ensure you have

4 EXECUTIVE SUMMARY/ INTRODUCTION The principles and definitions of the 18 week target count the referral to treatment (RTT) waiting times in totality. This is a positive step and allows the Trust to focus on delivering shorter waits and quality care for patients. The length of time a patient needs to wait 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. The successful management of patients who are waiting for elective treatment is the responsibility of a number of key individuals and organisations including Hospital Doctors, General Practitioners (GP s), Consortium Commissioning Groups and Trust Managers. If patients who are waiting for treatment are to be managed effectively it is essential for everyone involved to have a clear understanding of their roles and responsibilities. This document defines roles and responsibilities and establishes guidelines to assist staff in the effective management of waiting lists. Simon Wright Chief Operating Officer PURPOSE AND SCOPE The policy aims to provide the Trust with a consistent approach to the management of waiting lists, scheduling and booking across the organisation in accordance with National and local frameworks and definitions. This policy document applies to all patients who are referred to Warrington and Halton Hospitals NHS Foundation Trust (WHHFT). This policy document applies to all WHHFT staff involved in the management of patient access to WHHFT services. This policy has been designed to provide consistency and eliminate all duplicate systems throughout the Trust. It is imperative that the Hospital IT System is the single store of data used for the management of all waiting lists. It is essential that the electronic Hospital IT System is fully functional and that effective training and support is given to those staff involved in waiting list management. This will help improve data quality and improve confidence in the accuracy of waiting list information. Appropriate training programmes should support staff with special regard given to newly recruited staff. Divisions are responsible for ensuring that all staff involved in the content of this policy, both clinical and clerical, receive initial training and regular updates. The Trust will hold a record of patients waiting for an appointment/admission on computer systems approved by the Trust s Information Department. It will be current, accurate, and complete and subject to regular audit and validation. The Trust will not Page 4 of 44 Printed Copies may become out of date. Check online to ensure you have

5 hold deferred waiting lists. Trust administrative staff must not keep local records of patients choosing to wait or defer a reasonable offer of an appointment/admission. Patients should only be referred to the Trust if they are ready, willing and available to be treated within 18 weeks. The Trust will agree a convenient date and time with patients for appointments or admission following either partially or fully booked systems. Patients will be seen in clinical priority order when attending outpatients, diagnostic testing, or when admitted for elective day case or inpatient procedures. Patients of equal clinical priority will be treated in chronological order. A patient will only be placed on a waiting list for admission if:- o There is a sound clinical indication for the operation o The patient is clinically and socially ready to undergo surgery Appropriate, relevant and timely referral information is required to enable a patient to be offered an appointment or admission. Patients should be listed on the Decision to Admit (DTA) date and tracked according to the 18 week rules and definitions. Communications with patients should be informative, clear and concise. All additions to or removals from waiting lists must be made in accordance with this policy. Reasonable offer of date rules apply to all patients. The Trust will seek to make best use of its resources to the benefit of all patients by seeking to reduce the number of patients who Do Not Attend (DNA). Patients will be encouraged to be responsible for keeping their appointments. Out-Patients should only be followed up if there is a clinical need and all clinical information is available. The Trust will endeavour to work towards inclusion and equal access for all service users and is committed to ensuring that no equality target group (Black & Minority Ethnic, Age, Gender, Disability, Religion, and Sexual Orientation & Transgender) are discriminated against or disadvantaged by this policy and associated procedures. DUTIES AND RESPONSIBILITIES This section outlines the key responsibilities of key groups of staff within the Trust in relation to this policy. The list is not exhaustive and each group will have other roles and responsibilities that are not listed here. Chief Operating Officer The Chief Operating Officer will ensure the waiting list policy is implemented and adhered to. The Chief Operating Officer will performance manage the implementation of the Patient Access Policy via the KPI group, which reports directly to the Trust Board (via performance monitoring). The Chief Operating Officer will ensure the Trust is maximising its clinic and theatre capacity whilst adhering to the NHS Executive guidelines regarding: i) Total number on waiting list. ii) Cancelled operations/clinics iii) Waiting times targets. iv) Suspended Waiting List. Page 5 of 44 Printed Copies may become out of date. Check online to ensure you have

6 v) Planned Waiting List Director of Finance The Director of Finance will ensure robust and timely information is produced by the Information Team and made available to Trust management as appropriate. Managers The Managers will be responsible for ensuring all patients receive treatment within national and locally agreed targets, and that all staff adhere to the Trust Patient Access Policy and associated procedures. Management Teams will be responsible for monitoring the following:- i) Total number on waiting list. ii) Cancelled operations/clinics. iii) Waiting times targets. iv) Suspended Waiting List. v) Planned Waiting List. Consultants Each Consultant will decide which patients require adding to a waiting list and their clinical priority. Consultants will be responsible for the care of all patients listed on their waiting list including those suspended within National and locally agreed targets. Consultants and their clinical teams are required to provide at least six weeks notice before the date for commencement of the leave period, and submit the relevant form to the relevant Clinical Lead for approval. Requests that are submitted at less than six weeks notice that result in a loss of clinical activity will only be granted following an agreement to replace that activity at no additional cost to the Trust. The only exceptions to this rule will be following unforeseen circumstances or emergency situations. Consultants will be responsible for reviewing patient s records for those requiring rescheduling following a hospital cancellation to ensure patient care is not compromised. Consultants and their clinical teams will be responsible for ensuring all Choose and Book referrals and paper referrals are reviewed within one working day of receipt into the organisation. Consultants are responsible for ensuring their clinical teams complete electronic discharge summaries within 24 hours of a patient discharge. Information Management & Technology (I M &T) The information system trainers will work with users to ensure that training needs are met and underpinned with effective training and documentation. The I M & T Department will ensure: Data entry is accurate and complies with national and local data standards. Consistent waiting list reporting is achieved internally and externally. System changes are actioned in liaison with suppliers. Page 6 of 44 Printed Copies may become out of date. Check online to ensure you have

7 Software and process changes are implemented in liaison with users. Produce data quality reports on a monthly basis. Medical Records Clerks will be responsible for locating case-notes, preparing and delivering notes to the appropriate clinic/reception area prior to the clinic/patient admission taking place within the department remit. Choose and Book Directory of Services The Out patient Access Manager will be responsible for maintaining the Directory of Services (Dos) and ensuring outpatient referral processes are reviewed in line with the evolvement of Choose and Book. Appointments/Waiting List Coordinators The Appointments / Waiting List Coordinators will be responsible for adding and administration of patients to the OP/IP/DC/Diagnostic waiting list(s) on the Hospital IT System, as appropriate to their role. The day-to-day maintenance and management of waiting lists and PTLs is the responsibility of all Trust staff involved in the operational management of scheduling and booking admission/appointments. The waiting list/ptls must be validated routinely to ensure that that the waiting list does not contain patients who no longer require an admission/appointment. PTLs will contain a list of patients who are on the waiting list who require an admission/appointment within a defined period to meeting local/national waiting time targets. Wards & Departments Wards and Departments must ensure patients are admitted and discharged on the Hospital IT System; recording out-comes against pre-admissions if patients DNA or CANCEL. Ensure all case-notes are available for admission date and all patients movements within the hospital are accurately recorded on the IT system i.e. ward transfers, hospital transfers, admitting consultant changes, discharged. Theatre/Ward Managers Theatre/Ward Managers must contact the Waiting List Manager or SMOC (out of hours) before cancelling patients due to lack of bed availability, advising on the patient s length of wait and relevant circumstances and also inform Waiting List Coordinator/ Management Team of hospital cancellations in order to facilitate a new TCI date that is within 28 days. Pre operative Staff If patients are not medically fit for surgery, this must be clearly communicated to the GP together with what is an acceptable level of fitness and a clear management plan. Medical Secretaries Medical Secretaries must ensure all patient/gp correspondence is typed within 24 hours of a patient event and that the Hospital IT System is updated accordingly. Medical Page 7 of 44 Printed Copies may become out of date. Check online to ensure you have

8 Secretaries must also complete a minimum data set (MDS) form for patients being referred to another provider. Referrers (e.g. GPs, Dentists, Opticians) and Clinical Commissioning Groups Referrers and Clinical Commissioning Groups will: Adhere to WHHFT local Patient Access Policy and associated procedures. Comply with agreed referral pathways / criterion. Explain to patients their obligations to attend for appointments. Manage patients and review them as appropriate when informed by WHHFT that the patient has DNA d their admission/appointment and has been removed from the waiting list. Use their best endeavours to maximise the utilisation of the Choose and Book systems for referral of patients. Manage patients and review them as appropriate when informed by WHHFT that the patient has cancelled their admission on more than one occasion and has been removed from the waiting list. Manage patients and review them as appropriate when informed by WHHFT that they have not responded to a validation letter and have been removed from the waiting list. Manage patients and review them as appropriate when informed by WHHFT that the patient is not clinically fit to have the required procedure at the time of decision to treat. MANAGING WAITING LISTS, SCHEDULING AND BOOKING The successful management of patients who wait for elective outpatient appointments and treatments is the responsibility of a number of key individuals and organisations including General Practitioners, Trust Clinicians, Clinical Commissioning Groups and Trust Managers. Service Commissioners must ensure that long-term service agreements are established with sufficient capacity to ensure that no patient waits more than the guaranteed maximum time. Failure to commission and commit resources to funding adequate capacity will lead to longer waiting lists and times.. Trust Staff have an important role in managing Waiting Lists effectively. Treating patients and delivering a high quality, efficient and responsive service ensuring prompt communications with patients is a core responsibility of the hospital and the wider local health community. It is the responsibility of the Trust and of all staff to ensure that this policy is implemented in a fair and consistent manner to ensure that no equality target groups are discriminated against or disadvantaged by the implementation of this policy and associated procedures. The accuracy of published data is of paramount concern to the Trust. In support of data accuracy all transactions made on the Hospital IT System will be performed by staff in accordance with the training manual. This will be given to staff on completion of the relevant training course and prior to access rights being issued. An up to date document will be made available on the Trust s Intranet. Page 8 of 44 Printed Copies may become out of date. Check online to ensure you have

9 See Appendix 1 for a list of Key Performance Targets Patient Administration System To ensure consistency and the standardisation of reporting with Commissioners and the NHS Executive, all waiting lists are to be managed within the Hospital IT System. Manual Waiting list systems must not be used within the Trust. Booking systems To ensure that the Trust meets the targets for offering patient choice at first outpatient appointment and ultimately at all stages of a patient s journey the following booking systems will be adopted as best practice across the Trust: - Choose and Book* - Full Booking* - Partial Booking* * For definitions see Glossary The Trust expects that all new Outpatient referrals to elective outpatient Consultant clinics will be fully booked using the Choose and Book system. Referrals/Requests The Trust expects that all patients have had relevant access targets explained to them by their referrer, along with their responsibilities to make themselves available for their appointment prior to referral. The Trust expects one referral to be made for each separate condition. Referral letters/requests content must be clear and concise stating the clinical priority, reason for referral or request. The Trust s preferred method of referral management is by means of a pooled methodology, therefore where possible, referral letters/requests should be addressed to a specialty/service (i.e. Dear Dr Cardiology Clinic/CT Superintendent) to allow that specialty/service to direct the referral/request to the most appropriate member of the team and shortest waiting time. Where it is explicit that the patient has chosen or needs to see a particular consultant-led team, this must be written in the referral/request with the reason for this stated clearly. If the patient is referred using Choose and Book, the named clinician facility should be used. Prior Approval Scheme(s) GPs are no longer required to gain pre authorisation from their respective CCGs before making appropriate referrals into secondary care. The expectation is that GPs will manage the assessment of potential PLCPs within primary care and trusts will receive GP referrals directly. Where the GP is satisfied that the patient meets the PLCP criteria this will be clearly stated and documented and the trust may proceed with the specific treatment requested. Page 9 of 44 Printed Copies may become out of date. Check online to ensure you have

10 All other referrals will be for a consultant opinion only, and only if the consultant considers that the patient meets the PLCP criteria should treatment be offered. GP and Trust colleagues should therefore make patients aware that an initial referral does not automatically constitute authorisation for treatment. Following outpatient assessment the consultant will inform the GP either that the patient clearly meets the criteria and treatment will proceed, or that the patient does not meet the criteria. Patients who fulfil the criteria may then be placed on a waiting list according to their clinical need. The patient s notes should clearly reflect exactly how the criteria were fulfilled, to allow for case note audit to support contract management. Should the patient not meet the eligibility criteria this should be recorded in the patient s notes and the consultant should return the referral back to the explaining why the patient is in eligible for treatment? For any patients who do not meet the PLCP policy but it is deemed that the patient shows clinical exceptionality, an application for funding on exceptional grounds can be made from either primary or secondary care to NHS Merseyside s Individual Funding Request (IFR) team. Special requirements it is the responsibility of the referrer to indicate in the referral letter any special requirements a patient may have in terms of speech and sign interpretation, religious, cultural needs and disabilities (see section Equality & Diversity). Referrals from Other NHS Organisations Outside of England Non-contract elective referrals from NHS organisations outside of England will not be treated without prior approval from the appropriate health authority (please see Appendix 6 for a comprehensive list of non-england NHS organisations.). Referrals that are received from NHS organisations outside of England without a standard letter of authorisation will be returned by the Trust to the referrer to seek approval. It is the responsibility of the referrer to inform the patient of any subsequent delays to treatment. Consultants have a responsibility to ensure that internal outpatient referrals following emergency treatments are subject to the policy and guidelines set out by the different non-england organisations. See Appendix 6 for additional information. Consultant to Consultant Referrals All consultant to consultant referrals either internally or externally must be:- - in accordance with the Protocol for Referrals from Out Patient Clinics to Other Specialists / Trusts (Appendix 5) and - must be accompanied by an 18 week tracking proforma with the Minimum Data Set (MDS) completed. Page 10 of 44 Printed Copies may become out of date. Check online to ensure you have

11 - Notified to the patient s GP informing them of all new referrals explaining the reason for the referral and setting out the expectations. - Following identification of another condition outside the original referral remit the patient must be referred back to the GP. Inappropriate referrals/requests If the referral/request is for a service not provided by the Trust then the referral/request must be returned to the original referrer with advice. The Booking office must be informed and the referral/ request closed off the Hospital IT System. Mismatch of Consultant Interest and Patient Needs If a referral has been made to an individual who does not have the necessary skills for the needs of the patient, the professional prioritising the referral should re-route the referral to an appropriate colleague, prior to seeing the patient in clinic. Insufficient/illegible Clinical Information If the referral/ request does not provide sufficient/illegible information for the health care professional to make a decision, the letter should be returned to the original referrer. Down Grading of a referral If a healthcare professional wishes to down grade a Two Week Wait (2WW) or Urgent referral the prioritising healthcare professional must have a clinical conversation with the original referrer (documented in the notes) and the referrer asked to withdraw the two week wait referral status before any changes to the request are made on the Hospital IT System. Determining Priority of a Referral All patients who are added to a Meditech waiting list must be given a clinical priority of either Urgent or Routine. Equality and Diversity / Special Requirements The Trust strives to ensure that every service user is treated with dignity and respect in a safe environment. The services provided will be delivered in a fair and equitable manner. The Trust will not tolerate any practices that result in the provision of a lower standard of service due to unlawful discrimination. The services provided will be accessible and sensitive to the needs of the diverse community and will not disadvantage any service user on the grounds of age, disability, race, nationality, ethnic origin, gender, religion, beliefs, sexual orientation, caring commitments, social/economic background, HIV status, gender reassignment or any other difference. The Trust firmly believes that all services should be responsive and adaptive to individual needs of service users and carers. The Trust will ensure that these needs are at the centre of service delivery, as opposed to tradition or fear of change. Its services will not be based on assumptions, stereotypes and prejudice of any groups, but on information gained through consulting with service users, carers and the public. Page 11 of 44 Printed Copies may become out of date. Check online to ensure you have

12 In line with Trust procedures, all staff are required to obtain as much information on individual service users and carers needs, and to act on this information. This may include acquiring aids for a disabled person, contacting an interpreter for a non-english speaking patient, providing access to religious materials and/or delivering services that are culturally sensitive to the needs of service users and carers. All requests will be considered and the Trust will endeavour to ensure the highest quality services are delivered within the resources at its disposal. All special requirements must be notified to the appropriate department when informed of the appointment/admission date in order that the service can be booked. Where an appointment/admission date is cancelled/rescheduled, the appropriate department must be informed in order that the service required can be cancelled/rescheduled and avoid being charged. Interpreter - Where a patient requires an interpreter for an appointment /admission this must be highlighted at the top of a referral/request and also must be clearly state the exact type of interpreter required. Advocacy requests and enquires to: Patient Advocacy and Liaison Service (PALS) at WHHFT. Patient Transport patient transport for all first outpatient attendances must be booked by the patient, subject to meeting the eligibility criteria. Subsequent, patient transport arrangements will be booked via the patient transport office at WHHFT. War Pensioners - War pensioners should receive priority treatment but only if the condition referred into is directly attributable to injuries sustained during war periods. Overseas Visitors patient identified as an overseas visitor should be referred to the Chargeable Patients Officer. Disabilities/Special needs - The Trust is committed to providing, wherever possible, a booking system to support the requirements of individuals with disabilities, this may involve for example; booking an appointment time that is more suitable to their needs. We will continually work towards ensuring that individuals with disabilities are not disadvantaged by this policy; we will, through the Impact Assessment process & involvement with local disability groups, identify areas of concern and work in partnership to reduce or wherever possible eliminate these issues. Religious/Ethnicity The Trust is committed to providing, wherever possible, a flexible booking system to support the ethnic/religious requirements of service users, for example, more suitable appointments times or female interpreter for female service users. We will continually work towards ensuring that individuals due to their ethnic/religious requirements are not disadvantaged by this policy; we will, through the Impact Assessment process, in consultation with BME group, identify areas of concern, and work in partnership to reduce or wherever possible eliminate these issues. Page 12 of 44 Printed Copies may become out of date. Check online to ensure you have

13 Timeliness of and Adding a Patient to the Waiting List All patients requiring an appointment or treatment must be added to the Hospital IT System within 1 working day of the decision to refer/admit (DTA). The date of addition to the waiting list should always be the date the decision or receipt of referral was made, not the date of the transaction on the system. The decision to add a patient to a waiting list must be made by a Consultant, or under an arrangement agreed with the Consultant. It is the Consultants responsibility to list patients in chronological order. Decision to add to wait list or refer to diagnostics must be initiated at the point of decision. 18 week pathways All patients identified as starting a new 18 week pathway must have an 18 week pathway unique identifier created on MEDITECH. This is created when prompted to add an 18 week pathway on MEDITECH when registering a patient and/or adding a patient to the waiting list. Elective Admissions Only add patients to Waiting List when they have accepted Consultant advice for elective treatment. All elective patients must be listed for admission on MEDITECH within 1 working day of the Decision to Admit (DTA). Patients who subsequently become unfit or unable to accept an offered admission date due to personal/social reasons will have their clock adjusted. Patient Transfers When accepting the transfer of a patient from another Trust s waiting list, the DTA date used must be the date that the patient was added to the originating Trust s waiting list, not the date they were added to the WHHFT waiting list. Patient transfers will only be accepted with an inter-provider transfer form. Patients listed for Bilateral procedures or for more than one procedure Patients who require bilateral procedures will only be listed for the first side. Once the patient is fit, ready and able to have the second side done a new waiting list entry/clock start will be made. Private Patients If the patient is to be seen privately, the prioritiser or medical secretary must inform the appropriate booking office clerks to close the patient s episode off Hospital IT System. Where a patient has been seen privately, but needs to be listed for an NHS elective admission/appointment the patient must be treated in the same way as an NHS referral/request. For an outpatient appointment the referral/request source of referral will be recorded as PP. Page 13 of 44 Printed Copies may become out of date. Check online to ensure you have

14 HC(80)10 annex D and the DH Waiting Times website sets out guidance in relation to managing patients on to the NHS inpatient waiting list following private consultation. Reasonable Notice Outpatient Appointments: Patient attending outpatients will be offered two alternative dates with one weeks notice within the agreed local access time for the related specialty Diagnostic Appointments: Patients attending diagnostic tests will be offered two alternative dates with one weeks notice within the maximum waiting time of 6 weeks. Offers of Admission: Patients arranging their admission date will be offered two alternative dates with three weeks notice within the 18 week referral to treatment time. In the event that the patient cannot attend any of the dates offered, PAS will be updated to show the first of the offers as a deferment of the first appointment. The patient will then be offered a further appointment no more than two weeks from the second reasonable offer date but within the access time as specified above. If the patient is still unable to commit to an appointment after the three offers they will be returned to the care of their GP or referring clinician. Cancellations Patient Cancellations/Deferrals The principles and definitions of the 18 week target count the referral to treatment (RTT) waiting times in totality. The 18 week clock continues uninterrupted whilst the patient delays their treatment. However for diagnostics, patient deferrals and resets will be reflected and will adjust the diagnostic six week maximum waiting time. Outpatients: New patients will be allowed to cancel their appointment date where reasonable notification has been given to the Trust. Reasonable notification is defined as 48 hours prior to the date of attendance. However, by offering Patient Choice, patient cancellations should be minimised. Therefore, once a patient has accepted an offer that has been made within the definitions of reasonable notice, the patient will be given the opportunity to rearrange their appointment one further time. If the patient makes any further changes to their appointment they will be returned to the care of their GP or referring clinician. Admissions: If a patient wishes to rearrange their admission date or pre-assessment date, they will be given the opportunity to agree a new date at the time of the cancellation. If a patient wishes to rearrange their admission date a second time, they will be removed from the waiting list and referred back to their GP. If a patient is unsure as to whether they wish to proceed with surgery, the Admission Office will inform the patient s clinician for a decision to be made as to whether to discharge or review the patient in outpatients. If a patient wishes to be reinstated on the waiting list, a letter must be received from their GP within a 14 day period of removal from the waiting list. Following a referral letter being received by the Admissions Office, the patient will be reinstated on the waiting list and the clock reset Page 14 of 44 Printed Copies may become out of date. Check online to ensure you have

15 Diagnostics: Patients will be offered the next available diagnostic appointment. If the patient is unable to attend on this date they will be offered two alternative dates with at least one week s notice and within the maximum times (for diagnostics the National target is 6 weeks. In the event that the patient cannot attend on any of the offered dates PAS will be updated with the first and second reasonable offers. The patient will then be offered one further appointment within two weeks of the second reasonable offer date. within the overall 6 weeks target. If the patient is still unable to commit to an appointment, they will be returned to the care of their GP or referring clinician. The final offer will be recorded in PAS and a letter will be sent to their referring clinician advising of this action. This will stop the 18 week clock. Please note that the 18 week clock clock continues uninterrupted whilst the patient delays their diagnostic test. However, patient deferrals and resets will be reflected and adjust the maximum waiting time Hospital cancellations: No hospital imposed cancellations should occur at any stage of the pathway. As patients will only be offered appointments / admission within a three week window it is envisaged that all clinics / theatre sessions will be confirmed and appropriately staffed. In the event of sickness etc. divisions should attempt to cross cover clinics. Consultants and their clinical teams are required to provide at least six weeks notice before the date for commencement of the leave period, and submit the relevant form to the relevant Clinical Lead for approval. Where a patient s appointment/admission date is cancelled by the hospital with less than 6 weeks notice the patient will be offered an alternative date within 2 weeks ensuring that the appropriate waiting time target is not breached. Where a patient s admission date is cancelled by the hospital on the day the patient will be given the opportunity within 3 working days to agree an alternative date no later than 28 days from the cancellation date ensuring that the appropriate waiting time target is not breached. Re-instatement on the waiting list Patients who have been removed from the waiting list without being treated can be reinstated in exceptional circumstances. This may be if it is felt to be clinically appropriate to do so or if it is discovered there has been an administrative error. Patients who fail to attend (DNA) their pre-assessment or their admission will be reviewed by the Consultant or a member of the team, removed from the waiting list and returned to the care of their GP. The exception to this will be if there are compelling medical or social reasons why the patient should remain on the waiting list. The Trust will try to find a convenient date for patients who decline a reasonable offer of admission or who otherwise cancel an admission date so that they are treated as quickly as possible. Patients who decline more than one reasonable offer will be removed from the waiting list and returned to the care of their GP. Page 15 of 44 Printed Copies may become out of date. Check online to ensure you have

16 Patients who have been removed from the waiting list can be re-instated if it is in the best interests of their health for this to happen or if they have been removed inappropriately. Re-instatements for Clinical Reasons A patient may have been removed from the waiting list but now reinstatement is judged to be clinically appropriate. If a patient has been removed from the waiting list for reasons other than treatment and if the removal was as a result of following this policy and good practice guidance, reinstatement onto the waiting list will be a new episode of care. Patients who were removed as a result of a DNA or declining at least two reasonable offers of admission should not be re-instated using the original DTA date. However, it may not be necessary to ask the GP to re-refer by letter or for the patient to be seen in outpatients if their clinical circumstances have not changed within a 3 month period. In this case, patients will be put onto the waiting list as a new episode of care as the result of a telephone request. All circumstances should be recorded on the Hospital IT System to ensure a complete audit trail. Patients will only be re-instated as the result of a consultant decision. The consultant may also decide to take previous periods of waiting into account, change the patient s priority on the list and treat them earlier than other routine patients. Re-instatement following an Inappropriate Removal If the patient was removed from the waiting list and the removal was later found to be a mistake, then the patient must be re-instated without prejudice, as if he or she has never been removed. This is achieved by deleting the incorrect cancellation on the Hospital IT System. This maintains the original DTA date. No periods of suspension for the period that the patient was not on the waiting list must be entered. DNAs (Did not Attend) DNAs New Patients or Admissions for Treatment: Where a New urgent or routine priority patient has agreed an appointment date with reasonable notice and this has been clearly communicated to them (except for children where relevant legislation overrides this) and then subsequently does not attend (DNA) the patient will be referred back to the GP (or other referrer) and/or removed from the OP/IP/DC waiting list. Suspected cancer patients will be offered a second appointment/admission date. Should the patient subsequently DNA the second appointment/admission date the patient s case notes will be reviewed by the lead clinician and a decision on the further management of the patient will be made i.e. referred back to GP (or other referrer). Vulnerable Adults / Children where it is felt clinically appropriate to retain clinical responsibility, a further appointment is offered to the patient, the clock will continue from the date of referral. Routine follow-up/review and urgent or suspicious cancer patients who DNA appointments will be will be referred back to the GP (or other referrer). If however, Page 16 of 44 Printed Copies may become out of date. Check online to ensure you have

17 following review of case notes by the Consultant a further appointment is required the patient will be appointed via the partial booking process. Active Monitoring An 18 week clock maybe stopped when it is clinically appropriate to start a period of monitoring without clinical intervention or diagnostic procedures at this stage. If a patient who is being actively monitored decides within a 6 week period to proceed with their treatment, then a new 18 week clock would start. After a 6 month period they would need to be re referred into the consultant led service. Exceptions for removals from the waiting list Patients should not be removed from the waiting list if: They have declined two reasonable offers where previously they had an appointment/admission cancelled by the hospital or If the patient is clinically urgent or has a life threatening condition. Recording Clinical Outcomes ( Cashing-up ) All patient outcomes such as removals, admission/attendance, cancellations and DNAs should be recorded on Hospital IT System on the same day of the event. Following all outpatient attendances/dnas the clinic outcome form must be completed and returned to the appropriate reception and recorded on the Hospital IT System within 24 hours of the event. The reception clerks will produce a list of patients from the Hospital IT System without an outcome for the 18 week pathway 24 hours after the end of each clinic session. Secretaries and consultants are responsible for supplying the missing data within 2 working days of the clinic. Coding should indicate whether a clock has stopped or still ticking for the patients RTT. Treatment commencing and previously commenced is the clinician s decision. Clinic Template Changes Clinicians wishing to change templates must do so in conjunction with the Outpatients and Medical Records Service Manager and the Clinical Director for the Division. If a decision cannot be jointly made, the matter must be referred to the appropriate Associate Director of Operations/Exec Director. To avoid patients being inconvenienced a go-live commencement date for template changes must be agreed with the Senior Manager for Access, Booking & Choice. Retrieval of Medical Records Medical Records are an integral part of patient care and must be made available according to the agreed standards and targets outlined in the Medical Records Policy. Patient Correspondence Where a partial booking process is used an acknowledgement letter must be sent to the patient confirming that they have been placed on a waiting list and the expected waiting Page 17 of 44 Printed Copies may become out of date. Check online to ensure you have

18 time for an appointment/admission date. The letter must be sent within one working day of registration on to the Hospital IT System. As soon as a mutually agreed date has been arranged with the patient a confirmation letter must be sent to the patient. The letter is an audit trail of the arrangements and should contain the following core details: Patient s name Date letter sent to patient Date and time of admission/appointment agreed Where to report on arrival Response required from the patient Named contact for queries relating to admission/appointment Reference to instructions for admission/appointment and/or booklet Request to check bed is available on day of admission Reasons for checking bed availability Information about the planned treatment Any relevant patient Information must be sent or given to the patient prior to the admission/appointment date. Management Information Information for Hospital Management and Clinicians: Detailed information on hospital activity is available on the Trust s intranet system within the performance section and is updated monthly by the I M & T department. Waiting list pivot tables containing PTL information can be uploaded on to desktops of Trust staff on request for active monitoring. Information for Strategic Health Authority / Department of Health: Statistical information is submitted to the Department of Health to meet the statutory requirements as published in the data manual. QM08 returns may also be viewed in the performance section of Synapse. OUTPATIENT BOOKING AND SCHEDULING Introduction Since the implementation of the Choose and Book (CaB) appointment system, there are two processes in operation for managing referrals, i.e. electronic (CaB) and paper referrals. To accommodate these system changes, the policy will describe both processes. Choose and Book Choose and Book is the national electronic means for referring clinicians to refer a patient for their first outpatient appointment. The implementation of CaB is now mainstream within the Trust and is the preferred option for receiving referrals. Page 18 of 44 Printed Copies may become out of date. Check online to ensure you have

19 Referral Letters must be electronically attached to CaB by the referrer within 3 working days of the appointment request (decision to refer), where the appointment is more than 5 days in advance. Where the appointment is within less than 5 days then the referral must be attached within 24 hours. Accept and Reject Referrals all referrals must be accepted or rejected by the receiving clinical team within 1 working day. Referrals outstanding after 5 days will be automatically accepted by the Access, Booking & Choice team. Clinical teams will have a responsibility to review any patients booked into the wrong service whose referral was not accepted or rejected by the clinical team. Rejected Referrals - where a referral has been clearly referred into a clinically inappropriate service the referral must be rejected on CaB with a clear definitive reason and possible alternative action to be taken by the referrer. Redirection where a referral has been booked into a clinically inappropriate clinic within a service then the referral must be redirected in the appropriate clinic. Slot Availability it is the responsibility of the service management teams to ensure that there are sufficient slots available on CaB to ensure patients have reasonable choice of dates and times within the agreed national/local waiting times. Service Management teams must utilise the Future Slot Utilisation report on CaB to monitor slot availability and forward plan for any identified capacity constraints. The Access, Booking & Choice team will also alert service management teams when there are risks to slot availability. Polling Range - the maximum Polling ranges for slot availability on Choose & Book will managed by the CaB Manager with the agreement of the service management team in line with national/local guidelines on waiting times. Directory of Services (DOS) - the CaB Manager will manage the Trust s DoS on CaB. The group clinical directors will be responsible for reviewing and signing off the DoS on annual basis or when a service changes. The DoS must provide a clear description of the service and the clinics provided. Paper/Other referrals letters These include non-choose and book GP referrals, tertiary referrals, internal consultant to consultant referrals, external consultant to consultant referrals. All paper referrals must be processed within the following policy guidance in order to avoid patients being disadvantaged or delayed in accessing appointments. Receipt & Registration of Paper Referrals: All paper referrals must be sent directly to the appointments department at WHHFT.. Referrals received directly by a service or consultant must be date stamped and sent to the Appointments Department at WHHFT immediately (hand delivered to avoid delay). Registration of tertiary referrals : When registering a tertiary referral the name of the referring specialty and hospital must be recorded in the Referral Comments field on Hospital IT System. Page 19 of 44 Printed Copies may become out of date. Check online to ensure you have

20 Arranging a 1st Outpatient Appointments for Paper Referrals: Paper referrals will be processed in line with choose and book in order to that patients have fair and equitable access to services. Patients will be contacted and offered a provisional appointment prior to the referral being reviewed by the clinical team. Accepting and rejecting paper referrals: The same principles outlined for electronic CaB referral apply to paper referrals other than the outcome of the review of the referral will be manually recorded on the referral and returned directly to the Appointments Team within 2 working days for an Urgent or 5 working days for a routine. Follow-up Appointments Patients requiring follow up appointments within eight weeks should be offered a mutually agreed appointment time at hospital attendance using the Clinic Outcome Form. This must be recorded on the Hospital IT System as follow-up booked in clinic and will be counted as a fully booked appointment. Patients will also have the option to leave their Clinic Outcome Form with a receptionist or deposit it within the designated box within Main OPD. The patient will be contacted nearer the due date to agree a date and time for their follow-up. Diagnostic Intervention Follow-up Directorates will need to put in place full booking for all diagnostic interventions, coordinated with the relevant clinical follow up. Overbooking of Clinic Templates Overbooking of clinic templates is only permitted following authorisation from the outpatient clinic consultant and/or his/her medical secretary. Requests must be documented and retained for verification, if required. Templates will be booked according to their set up. A clinic will not be deemed overbooked if there are slots available for other booking types on other templates. New to Review Ratios The Information Department will provide clinical teams with regular information on ratios. Directorates should regularly review their follow-up ratios in comparison with regional and national norms and ensure that internal policies are reviewed to ensure optimum use of outpatient capacity. Private Utilisation of OPD The Outpatient department is available for private use pending room availability. Please refer to the Chargeable Patients Officer for further details relating to costs. Applications should be made to the Chargeable Patients Officer requesting the clinic room requirements. Any extra support such as a nurse needs to be arranged separately with the appropriate lead nurse. The consultant will be invoiced after the clinic has taken place. Page 20 of 44 Printed Copies may become out of date. Check online to ensure you have