Patient Access Policy

Patient Access Policy Version: 12.0 Purpose: To advise and inform staff clinical and administrative of the procedure for the management of patient referrals, appointments and elective admissions For use by: This document is compliant with /supports compliance with: All clinical, administrative and managerial staff who are responsible for managing referrals, appointments and elective admissions Care Quality Commission Standard 4c This policy complies with the Trust s Dignity & Respect Charter Trusts Child safeguarding and protection policy Trusts Private patients policy Trusts Treatment of overseas visitors policy Trusts Safeguarding Adults policy The Armed forces covenant This document supersedes: Access Policy Version 11.0 Approved by: Elective Care Programme Board Approval date: 10 th June 2015 Ratified by Combined Board Date Ratified 19 th June 2015 Implementation date: 1 July 2015 Review date 1 July 2016 In case of queries contact: Responsible Officer Directorate and Department Head of Access Operations Archive Date ie date document no longer in force Date document to be destroyed: ie 10 years after archive date To be inserted by Information Governance Department when this document is superseded. This will be the same date as the implementation date of the new document. To be inserted by Information Governance Department when this document is superseded. Registered Document 1637 Page 1 of 42

Version and document control: Version Date of Change Description* Author number issue 1.0 05.05.09 First Final Version Jon Tomlinson 2.0 17.07.09 Second Version Jon Tomlinson 2.1 15.10.09 Third Version Draft Robert Mayes 2.2 10.11.09 Third Version Draft Robert Mayes 2.3 24.11.09 Third Version Draft Robert Mayes 2.4 29.01.10 Approved Final Version Robert Mayes 3.0 01.02.10 Final Version Robert Mayes 3.1 09.09.10 First Version Draft Robert Mayes 3.2 17.09.10 Second Version Draft Robert Mayes 3.3 27.09.10 Third Version Draft sections 3.6 & 3.7 Brian Owens amended 4.0 1.10.10 Final Version Brian Owens 4.1 05.04.11 Changes to sections 3.3 & 4.1 to reflect wording of data dictionary Reasonable offers: 3.3.1 Additional bullet point 4.1.2 Additional Bullet Point Brian Owens 5.0 09.05.11 Final Version Brian Owens 6.0 08.11.11 Changes to sections 3 & 4 Brian Owens Multiple minor changes to numbering and job titles 7.0 24.8.2012 Changes to sections 2 & 4. Wendy Webb 3.2 additional section added and renumbered from 3.3 3.15 8.0 28.9.2012 Amendments following IST Review Wendy Webb amendments to:- sections: 1, 2 3, and 4. 9.0 July 2014 Updates to reflect new Organisational Alison Power, Carolyn structure and Lorenzo Regional Care and Tester, Tracey Choose and Book Changes Wakeling and Wendy Webb 9.1 6 th August Updated to incorporate comments Wendy Webb, Carolyn 2014 received from CCG Associate Director for Elective Care & internal IHT review Tester comments. This version was taken to 10.0 19 th August 2014 11.0 21 st 12.0 12.1 12.2 August 2014 15 th May 2015 ECPB 6 th August. Update for combined board, includes comments from Information Specialists within the trust. Also includes line by line review by Carolyn Tester / Wendy Webb to assure alignment and accuracy between sections Updated to incorporate further comments from Outpatient Services lead and CCG clinical executive. Updates following review by the national RTT team including : Addition of LPP information Addition of links to The Armed Services Wendy Webb, Carolyn Tester Wendy Webb, Carolyn Tester Vicki Decroo Registered Document 1637 Page 2 of 42

This is a Controlled Document Covenant Removal of the timeframe for patient pauses And other minor wording changes Review by Divisional and CCG lead Elective planned wording update Printed copies of this document may not be up to date. Please check the hospital intranet for the latest version and destroy all previous versions. Hospital documents may be disclosed as required by the Freedom of Information Act 2000. Sharing this document with third parties As part of the hospital s networking arrangements and sharing best practice, the hospital supports the practice of sharing documents with other organisations. However, where the hospital holds copyright to a document, the document or part thereof so shared must not be used by any third party for its own commercial gain unless this hospital has given its express permission and is entitled to charge a fee. Release of any strategy, policy, procedure, guideline or other such material must be agreed with the Lead Director (for hospital-wide issues) or Head of Operations for any divisional requests. To share this document must be directed in the first instance to Director of Nursing and Quality. For further advice see the Development and Management of Strategies, Policies, Protocols, Procedures, Guidelines and other Guidance Material Policy. Registered Document 1637 Page 3 of 42

PATIENT ACCESS POLICY Table of Contents SECTION 1 - INTRODUCTION... 6 1.1 Policy Statement and Rationale... 6 1.2 Key Principles... 7 1.3 Definitions... 9 SECTION 2 DUTIES AND RESPONSIBILITIES... 13 2.1 Chief Executive... 13 2.2 Chief Operating Officer... 13 2.3 Heads of Operations and Divisional Clinical Directors... 13 2.4 Consultants... 14 2.5 Clinicians undertaking Outpatient Clinics... 15 2.6 Central Appointments Team... 16 2.7 Responsibilities of Medical Secretaries / validation teams... 17 2.8 Lorenzo Support Team:... 17 SECTION 3 - OUTPATIENTS AND DIAGNOSTICS... 19 3.1 New patient referrals via NHS ereferral Service for out of area patients... 19 3.2 Referrals using Advice Letter Listing (ALL) and Referral Management Centres... 20 3.3 New patient paper referrals... 21 3.4 Reasonable offers... 22 3.5 Clock pause... 23 3.6 Outpatient Patient cancellations... 23 3.7 Patient cancellations (diagnostics)... 23 3.8 Hospital cancellations... 23 3.9 Did not attend (DNA)... 24 3.10 Follow up appointments... 24 3.11 Subsequent appointments... 25 3.12 Active monitoring... 25 3.13 TCI form... 25 3.14 Clinic outcome form... 25 3.15 Inter-provider transfers (tertiary referrals)... 25 SECTION 4 - ELECTIVE IN-PATIENTS/ DAY CASE PROCEDURES... 26 4.1 Reasonable offers... 26 4.2 Fit for Listing... 27 4.3 Determining patient priority... 27 4.4 Planned patients... 27 4.5 Clock pause... 28 4.6 Patient initiated delays... 29 4.7 Clinically initiated delays (or patient unfit for treatment)... 29 4.8 Bilateral procedures... 29 4.9 Pre-operative assessment... 30 4.10 Adding patients to the inpatient waiting list... 31 4.11 Selecting patients from the inpatient waiting list... 32 4.12 Hospital Cancellations... 32 4.13 Patient cancellations... 33 4.14 Did not attend (DNA)... 33 4.15 After the 18 week clock stops... 34 SECTION 5 - CANCER PATHWAYS... 34 5.1. Two Week Wait (2WW) Patients... 34 5.2 62-Day target 2WW referrals... 35 5.3 31-Day Target... 35 5.6 Interaction between 18 weeks, 31 and 62 day targets... 36 Registered Document 1637 Page 4 of 42

5.7 Adjustments to the targets... 36 5.8 Which patients are included within the cancer waiting time service standards?... 36 5.9 Which patients are excluded from monitoring under these standards?... 37 5.10 Cancer patients who do not attend... 38 5.11 First definitive treatment... 38 SECTION 6 TRAINING AND EDUCATION... 38 SECTION 7 DEVELOPMENT AND IMPLEMENTATION INCLUDING DISSEMINATION... 39 SECTION 8 MONITORING COMPLIANCE AND EFFECTIVENESS... 39 SECTION 9 CONTROL OF DOCUMENTS INCLUDING ARCHIVING ARRANGEMENTS... 40 Appendix - Tertiary Referral Letter (Minimum Data Set)... 41 Registered Document 1637 Page 5 of 42

SECTION 1 - INTRODUCTION 1.1 Policy Statement and Rationale 1.1.1 The Ipswich Hospital NHS Trust is committed to ensuring that patients receive treatment in accordance with national objectives and targets as laid down in the Service Level Agreement signed with Ipswich and East Suffolk Clinical Commissioning Group (Ipswich and East Suffolk CCG) and in line with the eligibility of a patient s right to treatment on the NHS. 1.1.2 The Patient Access Policy sets out the Trust s local access policy and takes account of guidance from the Department of Health and NHS England. This policy is intended to support a maximum wait of 18 weeks from referral to first definitive treatment, and is designed to ensure fair and equitable access to hospital services in line with the NHS constitution. 1.1.3 The overall aim of the policy is to ensure patients are treated in a timely and effective manner, specifically to: Ensure that patients receive treatment according to their clinical priority, with routine patients and those with the same clinical priority treated in chronological order, thereby minimising the time a patient spends on the waiting list and improving the quality of the patient experience. Reduce waiting times for treatment and ensure patients are treated in accordance with agreed targets. Reduce the number of cancelled operations for non-clinical reasons. Allow patients to maximise their right to patient choice in the care and treatment that they need. Increase the number of patients with a booked outpatient or in-patient / day case appointment, thereby minimising Did Not Attends, (DNA s), cancellations, and improving the patient experience. Ensure that the patients treatment is in line with other local and national policies including the oversees patient policy, Low Priority Procedures Policy (LPP) and any other relevant guidance in relation to the treatment of serving military personnel, their immediate families, war veterans and reservists as per the Armed services Covenant 05/11 Ensure that anyone who has lived lawfully in the UK for at least 12 months immediately preceding treatment is exempt from charges and has a right to treatment on the NHS within the RTT principles, patients from overseas not meeting this criteria will be treated in line with the overseas patient policy. 1.1.4 The purpose of this policy is twofold: it is both a statement of the policy for the management of patients on an 18 week referral to treatment (RTT) pathway and an operational guide for those staff who are involved in the management of these pathways. It sets out the roles and responsibilities, processes to be followed and establishes a number of good practice guidelines to assist staff with the effective management of patients who need to come into hospital for treatment as an out-patient, in-patient, day case or receive diagnostic treatment. 1.15 This Policy relates to the treatment of patients on active RTT pathways however patients not on an RTT pathway (i.e. emergency and elective planned patients) can expect their ongoing care to be managed within the same principle s in the careful monitoring of planned waiting lists treating in date to be treated order and the booking of appointment s within that pathway on a date to be seen basis Registered Document 1637 Page 6 of 42

1.2 Key Principles 1.2.1 The Trust has agreed the following underlying principles with Ipswich and East Suffolk CCG: o o o o o o Service provision should be patient-focused. Clinical input should drive the commissioning process. Organisational arrangements should support the provision of best care. A culture of partnership working should be developed. Information (except individual patient information) should be shared freely across organisations. Will not discriminate against serving military personnel, their families or veterans. 1.2.2 The trust relies on GPs and other referrers, supported by Ipswich and East Suffolk CCG, to ensure patients understand their responsibilities, (including providing accurate address and contact details) and potential pathway steps and timescales when being referred. This will help ensure that patients are: Referred under the appropriate clinical guidelines. That pre referral diagnostics have been completed as part of the referral process by the GP or referring practitioner Aware of the speed at which their pathway may be progressed. That any patient potentially needing an LPP or individual funding request procedure has been informed of the criteria and initial assessment where appropriate has taken place against this prior to referral, further screening for LPP s will be completed during the patient pathways as per the agreed LPP arrangements with the CCG. In the best position to accept timely appointments throughout their treatment. 1.2.3 In addition: Everyone involved in patient access should have a clear understanding of his or her roles and responsibilities This policy will be applied consistently and fairly across all services provided by the Trust Communications with patients should be timely, informative, clear and concise, preferably in writing to the patients address provided by the referrer, and the process of waiting list management should be transparent to patients. Nothing should be done to limit treatment for patients who have a clinical need for it (e.g. by adopting administrative practices designed to defer treatment). The Trust also has a responsibility to ensure no patient is added to a list inappropriately. Patients have responsibilities e.g. for keeping appointments, and giving reasonable notice to the trust if unable to attend. 1.2.4 The maximum wait for the whole of the patient pathway from GP referral to first definitive treatment is a maximum of 18 weeks for at least 90% of patients on an admitted care pathway, and at least 95% for a non-admitted pathway. This includes the various stages out-patient consultation, diagnostics and in-patient treatment. This is a maximum wait not a target and the majority of patients will need to be seen in a much shorter timeframe to ensure compliance with the overall target, and the Trust s intention is to treat all patients within 18 weeks where clinically and socially appropriate to do so. 1.2.5 The NHS Constitution commits the NHS to provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution. The handbook Registered Document 1637 Page 7 of 42

states that from the end of December 2008, patients can expect to start their Consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions unless they choose to wait longer, or it is clinically appropriate that they do so. Ipswich Hospital NHS Trust has committed to honor the Universal Pledge set out in the NHS Constitution. 1.2.6 As a general principle, the Trust expects that before a referral is made for treatment on an 18-week pathway the patient is both clinically fit for assessment and possible treatment of their condition, and ready to start their pathway from two weeks of the initial referral. The trust will work with Ipswich and East Suffolk CCG, GPs and other primary care services to ensure that patients understand this before starting an 18-week pathway. Ipswich and East Suffolk CCG is responsible for ensuring robust communication links are in place to feedback information to GPs. Patients will only be added to, or remain on, an elective waiting list if they remain fit for surgery, and will be in a position to accept dates for treatment within reasonable timeframes as defined within this policy. 1.2.7 The following professions and services accepted by Ipswich and East Suffolk CCG may commission 18-week pathways and start an 18 week RTT clock: General practitioners (GPs) General dental practitioners (GDPs) General practitioners (and other practitioners) with a special interest (GPSI s) Optometrists and Orthoptists Emergency Department (ED) Genito-urinary medicine clinics (GUM) National screening programmes Specialist nurses or allied health professionals with explicit Ipswich and Suffolk CCG authorization Prison health services Consultants (or Consultant-led services) An 18-week clock starts when any of the above healthcare professionals refers a patient to the Trust for any elective service (other than planned care) for the patient to be assessed and, if appropriate, treated before responsibility is transferred back to primary care. For paper referrals this is the date the trust receives the referral. For NHS ereferral Service referrals the clock starts on the date the patient calls to make an appointment and gives their unique 18 week booking reference number. For NHS ereferral Service ALLCAS referrals, this is the date in which the referral is received on the NHS ereferral Service system. If following completion of an 18-week referral-to-treatment period, a patient requires treatment for a substantially new or different condition then a new 18-week clock starts. This is a clinical decision made in consultation with the patient. Where a patient has been seen by a clinician privately but then decides to transfer their care to the NHS, and they are transferring onto an 18 week pathway then the 18 week clock starts at the point at which the clinical responsibility for the patients care transfers to the NHS (i.e. the date when the Trust accepts the referral for the patient). Private patients transferring in this way will be treated in turn within the terms of this Access Policy. If a patient wishes to transfer their care to the private sector following initial referral to the trust the clock will stop at the time of this transfer to the private provider is notified to the trust. Registered Document 1637 Page 8 of 42

1.2.8 The 18-week clock stops when the patient receives the first definitive treatment (see 1.2.9 below) for the condition for which they have been referred. This may occur following a consultation, receipt of results from a diagnostic test or following surgery or other specific treatment. The following clinical decisions stop the clock, on the date the decision is communicated to the patient and GP, and original referrer if not the GP: First definitive treatment. Decision not to treat. Decision to embark on a period of active monitoring. Decision to add a patient to a transplant list. Decision to return the patient to primary care for non-medical/surgical Consultant-led treatment in primary care. Decision to return the patient to Referral Management Centre (RMC) etc for treatment if the treatment is not to be medical or surgical Consultant-led treatment. The clock also stops or is paused when the patient declines treatment, or two reasonable offers of treatment (section4.1), or DNA s, either their first or follow-up outpatient appointments, diagnostic appointments, pre-operative assessment or inpatient date 1.2.9 First definitive treatment is defined as a clinical intervention intended to manage a patient s disease, condition, or injury and avoid further intervention. Treatment will often continue beyond the first definitive treatment and after the clock has stopped. 1.2.10 Patients will be advised when cancelling their 1 st appointment that a second cancellation may result in them being removed from the waiting list and referred back to their GP. This will be subject to Clinical review and confirmation 1.2.11 Administration teams (Including reception, booking and medical secretary teams) managing patient pathways will ensure the referral is closed at the time the treatment and any associated follow up is complete or when a patient DNA as per this policy Patients needing follow up will be placed on an access plan detailing that level of follow up and timescale required if the appointment is outside of 6 weeks from the date of request. Appointments for within 6 weeks will be given at the time of request whenever possible. Patients discharged from follow up but with agreement from the clinician that the patient can ring in if needed within a set timescale (SOS) will be discharged and the referral reopened if contact is made from the patient for subsequent follow up care. 1.3 Definitions The following section sets out the definitions issued by the Department of Health that have been used in this policy. 18-week referral to treatment (RTT) period The part of the patient s care following initial referral which initiates a clock start, leading up to the start of the first definitive treatment or other 18 week clock stop point. Registered Document 1637 Page 9 of 42

Active monitoring (previously known as Watchful waiting ) Active Waiting List (Waiting list types: Elective Waiting Elective Planned) Where it is clinically decided to start a period of monitoring in secondary care without clinical intervention, or diagnostic procedures at that stage. The list of elective patients who are fit and able to be treated at that given point in time. The active waiting list is also the list used to report national waiting times statistics. ASI s Cancelled Operations/procedures NHS ereferral Service Chronological Order (in-turn) Convert(s) their UBRN Decision to admit Decision to treat Did Not Attend (DNA) DM01 DH Appointment Slot Issues If the Trust cancels a patient s admission on the day of the admission/procedure for a nonclinical reason (eg lack of theatre time) the Trust is required to rearrange a new operation/procedure date within 28 days of the cancelled date, or within target wait time, whichever is the soonest. The offer must be made within 5 days of the cancellation. NHS ereferral Service is a national electronic referral service that gives patients a choice of place, date and time for their first Consultant outpatient appointment. This replaced Choose and Book. This is a general principle that applies to patients categorised as requiring routine treatment (as opposed to urgent treatment). All these patients should be seen or treated in the order they were initially referred for treatment (Clock Start). When an appointment has been booked through NHS ereferral Service, the UBRN is converted. Where a clinical decision is taken to admit the patient for either a day case or inpatient treatment. Where a clinical decision is taken to treat a patient as an inpatient, day case and / or performed in other settings eg outpatients. Patients, who have been informed of their date of admission or pre-assessment (inpatients/day case), diagnostics or appointment date (outpatients) and who, without notifying the hospital, did not attend. Diagnostic Monthly Reporting Department of Health Registered Document 1637 Page 10 of 42

Elective admission / elective patients Elective Planned Elective Waiting In-patients are classified into two groups, emergency and elective. Elective patients are so called because the Trust can elect when to treat them. Patients who are to be admitted as part of a planned sequence of treatment or investigation. Patients awaiting elective admission who have yet to be given an admission date. Entitlement to use the NHS Entitlement to use the National Health Service free of charge is based on where a person normally lives regardless of their nationality or whether they hold a British passport or have lived and paid National Insurance contributions and taxes in this country in the past. Anyone who has lived lawfully in the UK for at least 12 months immediately preceding treatment is exempt from charges First definitive treatment Low Priority Procedures Outpatients PTL An intervention intended to manage a patient s disease, condition or injury and avoid further intervention. What constitutes First Definitive Treatment is a matter of clinical judgement in consultation with others as appropriate, including the patient. Procedures as detailed in the list maintained and controlled by the CCG that require specific referral criteria to be adhered to and specific agreement go procedure from the CCG. Patients referred by a General Practitioner (medical or dental) or another Consultant / health professional for clinical advice or treatment. Patient Tracking List. A report used to track the patient journey throughout their 18 week pathway. RMC Referral Management Centre. RTT Referral to Treatment. From December 2008 patients will only wait 18 weeks from the Referral to the Treatment Registered Document 1637 Page 11 of 42

TCI (To come in) Tertiary Referrals UBRN A proposed future date of elective admission A tertiary referral hospital (also called a tertiary hospital, tertiary referral centre, or tertiary care centre, or tertiary centre) is a hospital that provides tertiary care, which is health care from specialists in a large hospital after referral from primary care and secondary care. Unique booking reference number use for NHS ereferral Service The patient is notified of this on their appointment request letter when generated by the referrer through NHS ereferral Service. The UBRN is used in conjunction with the patient password to make or change an appointment. Military Veteran Anyone who has served 1 day or more in HM armed forces whether as a regular or reservist member Registered Document 1637 Page 12 of 42

SECTION 2 DUTIES AND RESPONSIBILITIES 2.1 Chief Executive The Chief Executive is ultimately accountable to the Trust Board for ensuring that effective processes are in place to manage patient care and treatment that meet national and local targets and standards as set out in the Trust s Service Level Agreement with Ipswich and East Suffolk CCG, and for achieving these targets. 2.2 Chief Operating Officer The Chief Operating Officer is the Executive Lead for clinical operations and thus responsible: Through the Heads of Operations and Divisional Clinical Directors for ensuring that effective processes are in place to manage patient care and treatment that meet national and local targets and standards as set out in the Trust s Service Level Agreement with Ipswich and East Suffolk CCG. With Divisional Head of Operations and Divisional Clinical Directors for achieving access targets, including Referral to Treatment Times, NHS ereferral Service (patient appointment systems) and cancelled operations. For implementing effective Trust-wide monitoring systems to ensure compliance with this policy and avoid any breaches in targets. With Divisional Heads of Operations and Divisional Clinical Directors for monitoring progress against achievements of the targets and taking action to avoid any potential breaches. With Divisional Heads of Operations and Divisional Clinical Directors for managing any actual breaches in achieving targets. For keeping the Trust Board and Trust Executive informed of progress in meeting access targets and any remedial action taken. 2.3 Heads of Operations and Divisional Clinical Directors The Head of Operations and Divisional Clinical Director for each Division have the overall responsibility for implementing and adherence to this policy within their Division. This includes: Delivering operational targets for service delivery in line with the Annual Business Plan to include national targets including 18 weeks and all other key access targets. Responsible Officers for the management, communication and dissemination of the Trust Access Policy. Ensuring that principles of managing demand, activity, capacity and variation are embedded in service development and part of business cases for investment and development of services. Ensuring that effective processes are in place to manage patient care and treatment that meet national and local targets and standards for each speciality covered by the Division as set out in the Trust s contract with Ipswich and East Suffolk CCG Managing the resources allocated to the Division with the aim of achieving access targets. This includes having staff and other resources available to operate scheduled outpatient clinics, patient treatment and operating theatre sessions and avoid the need to cancel patient treatment. Registered Document 1637 Page 13 of 42

Working with other Divisionsal Heads of Operations and Divisional Clinical Directors to provide a joined-up approach to implementing this policy and achieving access targets, particularly around outpatient and operating theatre capacity and availability of diagnostic services. Achieving access targets, including Referral to Treatment Times, NHS ereferral Service (patient appointment systems) and cancelled operations. Ensuring that the duties, responsibilities and processes laid down in this policy are implemented within the Division. Ensuring that all Division staff who need to operate this policy are aware of this policy and receive training as detailed in Section 6 of this policy. Implementing effective monitoring systems within the Division to ensure compliance with this policy and avoid any breaches in targets; to escalate any actual or potential breaches to the Chief Operating Officer. Implementing systems and processes that support data quality and for validating data to ensure that all reports are accurate and produced within agreed timescales. Ensuring that any Outpatients Outcome Form returned via Central Appointments Team due to conflict or missing data are reviewed and returned within one working day to ensure compliance with contractual requirements. Ensure that any non-medical staff who are undertaking clinics are competent in the completion of Outcome Sheets, including the 18 week rules and to arrange training if issue identified. For the accurate resolution and return of any Outcome Sheets that have been escalated by the Central Appointments Team as being incomplete or queried. Resolution within two working days of any Outcome forms that are escalated for resolution to the Head of Operations as completion of Outcome Sheets is a clear accountability issue in relation to with Patient Safety, Fines and Contractual implications if not undertaken effectively. NOTE: Day to day operational management of this policy will be delegated to Divisional Operational Leads as set out in the governance arrangements for each Division. 2.4 Consultants 2.4.1 NHS ereferral Service and ALLCAS referrals: Each Consultant is responsible for: Reviewing all patient referrals directly within the NHS ereferral Service. For those accepted for an outpatient appointment, to allocate a clinical priority and to shortlist within NHS ereferral Service. For those requiring a management plan, to produce the plan and send to the GP within 3 working days. For rejected referrals, an automated response will be sent to the GP via the NHS ereferral Service system. Managing the patient s care and treatment and working with their Division Head of Operations, Divisional Clinical Director and clinical colleagues to ensure that this is provided within the timescales laid down by local and national targets and standards. Alerting their Divisional Head of Operations of any potential or actual breaches of targets. Managing medical staff to ensure that scheduled outpatient clinics, patient treatment and operating theatre sessions are held and avoid the need to cancel patient treatment. Managing waiting lists and deciding on patient admissions/treatments in line with clinical priority and order of inclusion on the waiting list. Registered Document 1637 Page 14 of 42

Working with colleagues to prevent the cancellation of patient admissions for non-clinical reasons and taking action to reschedule any patients so cancelled. Communicating accurate waiting time information to patients, their families and carers and dealing with any queries, problems or complaints in line with Trust policy. Assisting with the monitoring of waiting lists and data quality reports. Responsible for completion of their outcome forms for their own and their junior staff. Ensure that they and any junior staff who are undertaking Clinics are competent in the completion of Outcome Sheets, including the 18 week rules. 2.4.2 Paper / Fax referrals: Each Consultant is responsible for: Receiving the paper/fax referral from the central appointments team. Accept or reject referral on paper form. For accepted referrals, provide clinical priority and pass back to the central appointments team for booking For rejected referrals, dictate a letter to be sent back to the GP and arrange for medical secretary to scan into evolve. 2.4.3 Consultant to consultant referrals: Consultant to Consultant (C2C) are only to be used where the patient s condition relates to the original referring condition or where the referral is clinically urgent and would otherwise be referred on a 2WW pathway. Where it is identified that the patient requires a non-urgent treatment other than for the referred condition, then the patient will be discharged to their GP for a separate referral. NOTE: Completion of Outcome Sheets is a clear accountability in relation to Patient Safety and contractual implications if not undertaken effectively 2.5 Clinicians undertaking Outpatient Clinics Managing clinical staff to ensure that scheduled outpatient clinics, patient treatment and operating theatre sessions are held and avoid the need to cancel patient treatment. Managing waiting lists and deciding on patient admissions/treatments in line with clinical priority and order of inclusion on the waiting list. Ensuring that patients referred for LPP procedures are assessed against the set criteria as laid out by the commissioner and documentation of this is contained within the medical record from the consultation That the LPP gateways are adhered to as per the LPP policy Working with colleagues to prevent the cancellation of patient admissions for non-clinical reasons and taking action to reschedule any patients so cancelled. Communicating accurate waiting time information to patients, their families and carers and dealing with any queries, problems or complaints in line with Trust policy. Providing patient information leaflets related to the relevant clinical condition to support the patient and careers with treatment options and decision making at the time of the appointment Assisting with the monitoring of waiting lists, data quality and review of reports. Responsible for completion of their outcome forms for their own and their junior staff. Ensure that they and any junior staff who are undertaking Clinics are competent in the completion of Outcome Sheets, including the 18 week rule Registered Document 1637 Page 15 of 42

2.6 Central Appointments Team 2.6.1 Paper / Fax Referrals: All paper/fax referrals will come into the trust directly to the central appointments team. They will ensure that the referral is date stamped, indexed and entered onto Lorenzo Regional Care. The central appointments team will pass to the appropriate clinician to accept or reject the referral. For accepted referrals, the clinician will assign clinical priority For rejected referrals, the clinician will dictate a letter back to the GP confirming the decision which will also be scanned into evolve and closed on LRC by the medical secretary For accepted referrals, once clinical priority is assigned, it will be passed to the central appointments team to arrange for the referral documentation to be scanned into evolve and subsequently contact the patient to make an outpatient appointment, ensuring wherever possible that patients are given reasonable notice and choice relating to appointment dates. The outpatient letter will be sent to the print queue for printing and sending to the patient. 2.6.2 NHS ereferral Service ALLCAS referrals: ALLCAS electronic referrals are received into the Trust via the NHS ereferral Service system. Assuming the ALLCAS referrals require an appointment, (following the grading & shortlisting process which is covered by the clinician/medical secretary), the central appointments team will contact the patient and make an outpatient appointment, ensuring wherever possible that patients are given reasonable notice and choice relating to appointment dates. Any issues relating to insufficient capacity will be raised to the Operational Lead for resolution. The central appointments team will ensure the referral documentation is passed to the scanning team for uploading onto evolve in time for the clinic appointment. The outpatient letter will be sent to the print queue for printing and sending to the patient. 2.6.3 NHS ereferral Service direct bookings: Note: these are direct bookings made on the NHS ereferral Service system, hence do not involve the Central Appointments Team 2.6.4 Central Appointments Team general responsibilities: To book outpatient appointments, assuming a notice of 5 working days has been given. The trust operates a Call reminder service which is automated from the LRC system. The central appointments team will ensure that all outpatient appointment offers are recorded on Lorenzo Regional Care. To enter full free text reasons for cancellations onto Lorenzo Regional Care. To ensure Lorenzo Regional Care is updated correctly and timely with any patient choice decisions. Registered Document 1637 Page 16 of 42

To ensure the appropriate Referral to Treatment (RTT) status is accurately & timely recorded on Lorenzo Regional Care. This should be entered onto the system within 24 hours of the clinic. To refer any problems or suspected/potential breaches of policy or compliance with RTT targets to the appropriate Division Operational Lead and the Head of Operations. To resolve any issues with Outcome Sheets either with the Clinician following the clinic or to escalate to the Head of Operations within the division for joint resolution within 2 working days. To undertake audits of timeliness of outcome sheet data input and report to Head of Operations for outpatient services. Responsible Officer for the management, communication and dissemination of the Trust Access Policy within their team. 2.7 Responsibilities of Medical Secretaries / validation teams To maintain an up to date and accurate waiting list for their consultant To ensure that any consultant to consultant referral requests are added onto LRC at the time of the request being made by the referring consultant. To arrange for patients to be entered onto Waiting lists, or update a provisional waiting list entry to full entry, within 5 days of Decision to Admit being made and to inform the patient in writing that they are on a waiting list. To ensure when a decision to admit is made in a clinic, the clinic attendance date is entered onto the Lorenzo Regional Care waiting list entry screen. To enter all patient contact details within additional information on the waiting list entry screen (to maintain a full audit trail). To ensure patients are given reasonable notice and choice relating to admission dates. Ensure that all admission offers are recorded on Lorenzo Regional Care. To ensure pause periods are entered onto Lorenzo Regional Care according to this policy. To enter full free text reasons for suspensions and cancellations onto Lorenzo Regional Care. To regularly validate waiting lists to ensure lists are complete and correct at all times. To ensure Lorenzo Regional Care is updated correctly and timely, including free text reasons with any patient choice decisions. To ensure the appropriate Referral to Treatment (RTT) status is accurately & timely recorded on Lorenzo Regional Care. For rejected referrals, to ensure that the documentation is scanned into evolve and the referral closed on LRC. To track patients awaiting results, ensuring once results are received, the clinician reviews and advises on next steps. To close referral where necessary and to request add to access plan for face to face follow up or telephone appointment if necessary. Also confirm action taken to GP. For any short notice clinics (ie under 5 working days), the operational leads or coordinators/medical secretaries will liaise with and book the patients directly. 2.8 Lorenzo Support Team: For NHS ereferral Service ALLCAS referrals, as a failsafe mechanism, if the referral hasn t been accepted or rejected within 5 working days, the Lorenzo support team accept the referral on behalf of the specialty. This is required in order to retain the Registered Document 1637 Page 17 of 42

referral and associated documentation within the NHS ereferral Service system. It is then ready for the specialty to review, i.e. grade and shortlist or reject. For setting up and cancelling clinics in line with clinic templates as requested by the Division within 24 hours of request. Note - If requested to cancel a clinic with less than six weeks notice this must not be cancelled unless authorised by the Divisional Director or Head of Ops. 2.9 Chief Information Officer is responsible for: The management of the hospital s computerised information systems, Medical Records function and the IT training team. Quality assuring and producing accurate performance management data for use by Trust Managers and for reporting data to external sources. Providing IT training for all staff required to operate this policy. Providing Data Quality reports to assist the 18 week pathway tracking. 2.10 All staff All staff will ensure that any data created, edited, used, or recorded on Trust IT systems within their area of responsibility is accurate and recorded in accordance with this policy and other Trust policies relating to collection, storage and use of data in order to maintain the highest standards of data quality and maintain patient confidentiality. All patient referrals, treatment episodes and waiting lists must be managed on the Trusts Patient Administration System (Lorenzo LRC) and all information relating to patient activity must be recorded accurately and in a timely manner. Monitoring responsibilities This policy will be formally approved by the Elective Care Programme Board and ratified by Combined Board. Alterations and amendments to this policy will be approved and ratified by these bodies. Issues around interpretation and application of this policy will be initially resolved by the Chief Operating Officer. Where any matter cannot be resolved at this level it will be escalated to Trust Executive for ultimate resolution. Registered Document 1637 Page 18 of 42

SECTION 3 - OUTPATIENTS AND DIAGNOSTICS 3.1 New patient referrals via NHS ereferral Service for out of area patients 3.1.1 NHS ereferral Service is a national electronic referral service that gives patients a choice of place, date and time for their first Consultant outpatient appointment. The patient is allocated a Unique Booking Reference Number (UBRN). 3.1.2 Patients exercising choice of hospital and deciding to receive treatment at the Ipswich Hospital will be referred in one of the following ways: The GP or one of their administrative staff will book an outpatient appointment by choosing one of the available clinical appointment slots accessed via the NHS ereferral Service computer system. The surgery will print off a letter confirming the appointment date, time and other relevant details and give this to the patient prior to their leaving the surgery. The GP surgery will have ensured any referral criteria are adhered to and pre referral diagnostics are complete prior to undertaking the referral. Patients who do not meet the pre referral criteria will have the referral rejected as an inappropriate referral and the GP informed. The GP is responsible for informing the patient in this instance. For patients not wishing to book a clinic appointment immediately, or when no appointment is available on the system they will be given a UBRN after the GP has entered the initial referral onto the NHS ereferral Service system. The patient can then subsequently access the NHS ereferral Service website themselves and book an outpatient appointment, or contact the National Telephone Appointment Line to organise an appointment. Where no appointment slots are available, the national team will notify the trust of an appointment slot issue (ASI) via email the following day, and for these patients the clock starts on the day the email is received by the Trust. It is then the trust s responsibility to contact and book the patient appointment. 3.1.3 The RTT clock starts when a patient activates their UBRN, this can be done either by the referring GP, or one of their administrative staff booking an appointment using the C NHS ereferral Service system, by the patient themselves making booking online using the NHS ereferral Service system, or by the patient contacting the NHS ereferral Service National Call Centre. The hospital will be notified of the appointment details as soon as the appointment is booked and will show on the relevant speciality work list. This will start the 18 week clock. 3.1.4 Once the appointment booking has been completed, it will appear on individual Consultant s work lists which are accessed each working day by his/her Medical Secretary. A list of new referrals are printed off and passed to the Consultant who confirms whether or not he/she accepts the referral. Any referrals not acceptable are either moved to another Consultant, or rejected and referred back to the patient s GP. 3.1.5 Where appropriate, GP s are being encouraged by CCG s to use generic Dear Doctor letters which can be allocated by the Trust to an appropriate Consultant with the shortest waiting time. GP s must retain the flexibility to refer to a named Consultant but the Trust will offer the patient an alternative Consultant if the named Consultant would exceed the maximum waiting time target. 3.1.6 The Trust s aim is to receive all outpatient referrals via an electronic referral using the NHS ereferral Service system in line with national guidance and best practice. Registered Document 1637 Page 19 of 42

3.1.7 The Trust will ensure that all Consultant led new patient clinics have sufficient slots available for GP s/patients to book via NHS ereferral Service Book in line with national targets. 3.1.8 If a NHS ereferral Service appointment has been booked in the correct speciality, but in an incorrect clinic, it is the responsibility of the receiving clinician to re-direct the appointment to the appropriate clinic rather than rejecting back to the GP. The patient must be informed if the appointment is to be re-booked and given the opportunity to agree a convenient date within the agreed Trust timeframe. The 18 week clock continues ticking throughout this process. 3.1.9 If the NHS ereferral Service appointment has been booked in an incorrect speciality, it is the responsibility of the receiving clinician to re-direct the appointment to an appropriate clinic in the correct speciality rather than rejecting back to the GP. The patient must be informed if the appointment is to be re-booked and given the opportunity to agree a convenient date within the agreed Trust timeframe. The 18 week clock continues ticking throughout this process. 3.1.10 In both cases (sections 3.1.8 and 3.1.9 above), if the Trust is unable to contact the patient after two attempts, an appointment is to be booked and confirmation sent in writing. 3.1.11 Referrers are asked to ensure letters are received within a maximum of three days for a routine referral and one day for an urgent referral to enable the Trust to confirm the correct booking slot and ensure that the appropriate clinical information is available for the clinician to review. 3.1.12 All referrals made via the NHS ereferral Service system should be reviewed by the clinician or nominated staff member within a three working day (72 hours) period. Any referrals which are not reviewed in this designated timeframe will be automatically accepted by the Trust. 3.1.13 GP s can request individual Consultants to provide advice and guidance under the NHS ereferral Service process. Any advice and guidance requests must be reviewed by the clinician to whom they are directed, and responded to within 72 hours of receipt. 3.1.14 Veterans receive their healthcare from NHS trusts, and should receive priority treatment where it relates to a condition which results from their service in the armed forces, subject to clinical need. 3.2 Referrals using Advice Letter Listing (ALL) and Referral Management Centres 3.2.1 The Trust has a facility where Specialities review referrals from GP s in NHS ereferral Service using ALL. These are reviewed by the consultant in 3 working days and processed and booked on LRC by the Central Appointments Team. The GP surgery will have ensured any referral criteria are adhered to and pre referral diagnostics are complete prior to undertaking the referral. Patients who do not meet the pre referral criteria will have the referral rejected and the GP informed. The GP is responsible for informing the patient in this instance. 3.2.2. Any referrals received via ALL and not reviewed after 5 working days will be automatically accepted by the Lorenzo support team for the consultant to grade, shortlist, provide a management plan or reject. Registered Document 1637 Page 20 of 42

3.2.3 The following specialties are excluded from ALL and go through a referral management centres. Ophthalmology 3.2.4 Patients that have been referred via this route, whose treatment has commenced their 18 week clock will commence from the date of receipt of referral from the RMC. 3.2.5 The LPP first gateway includes a review of all referral s into the trust by the LPP nurse (employed by the commissioner) to identify any that do not on first inspection adhere to the referral criteria. Referrals that are outside of any LPP criteria will be rejected back to the GP by the LPP nurse with reasons and the referral closed in LRC by the appointment s centre. The outcome of this review if rejected will be kept on evolve within 3 days of the referral being received in the trust. 3.3 New patient paper referrals 3.3.1 On receipt of a paper referral from a referring profession, the Trust aims to contact a patient within 5 working days of the paper referral being accepted. If unable to contact the patient then further attempts will be made and a letter will be sent to the patient requesting that they contact the Hospital. Where a patient does not make contact with the Hospital, the patient will be returned to the care of their GP to consider whether they still wish to be referred. 3.3.2 All new paper based referrals (with the exception of 2 week wait cancer referrals) will be date stamped, scanned and registered/entered onto Lorenzo Regional Care on receipt of referral and within 24 hours of receipt of the referral letter. This date is entered onto the system as the first date that the referral was received by the Trust and starts the 18 week clock. If the patient has had an assessment, but no treatment in a Primary Care clinic or Referral Management Centre or any other provider then the 18 week clock start is the date that the referral was received in the Referral Management Centre. The same principle applies for referrals from other Trusts. 3.3.3 Referrals must include full demographic details, including NHS number and telephone numbers (both day and evening, if possible) to reduce administrative time contacting the patient. It is the responsibility of the referring GP to ensure that the referral letter contains accurate and up to date demographic information regarding the patient. The GP surgery will have ensured any referral criteria are adhered to and pre referral diagnostics are complete prior to undertaking the referral. Patients who do not meet the pre referral criteria will have the referral rejected and the GP informed. The GP is responsible for informing the patient in this instance. 3.3.4 Similarly, if the patient has been referred internally (for the same condition) by a clinician to another Consultant and is still awaiting treatment, then the 18-week clock continues to tick from the original referral date. 3.3.5 Referral letters must be passed to the Consultant within 24 hours of receipt. It must be ensured that referral letters are delivered prior to and immediately after bank holidays. Referrals should be prioritised within 72 hours of receipt by the Consultant to whom the patient has been referred and then sent directly to the Outpatient Appointment Team. Any generic Dear Doctor referrals should be prioritised within the speciality to which the patient has been referred within the same timescale. Registered Document 1637 Page 21 of 42