PATIENT ACCESS POLICY V3

PATIENT ACCESS POLICY V3 State whether the document is: x Trust wide Business Group Local State Document Type: x Policy Standard Operating Procedure Guideline Protocol APPROVAL & VALIDATION Assurance Risk Committee Business Group Quality Board Stockport PCT Elective Care Board DATE OF APPROVAL / VALIDATION Business Group Quality Board November 2012 Assurance Risk Committee December 2012 INTRODUCTION DATE December 2012 DISTRIBUTION REVIEW All Operational and Business managers, Associate Directors, Medical Secretaries, Waiting List Officers, Consultants, Outpatient Managers, Call Centre Staff and Cancer Management Original issue date: 2009 Review Date: December 2014 CONSULTATION EQUALITY IMPACT ASSESSMENT (Tick) RELATED APPROVED TRUST DOCUMENTS AUTHOR/FURTHER INFORMATION Trust-wide PTL Group Surgical & Critical Care Business Group Board Stockport PCT Elective Care Board Screening x Initial Full DNA Policy for Children and Young People Cancer Operational Policy Joanne Pemrick Performance & Quality, Surgical & Critical Care BG THIS DOCUMENT REPLACES Patient Access Policy - Version 2 (February 2011) Document Change History: Issue No Page Changes made (include rationale and impact on practice) 2 Amalgamation of SNHSFT, CHS and T&G policies. 2 Additional supporting narrative to comply with IST policy proforma. 2 3 Change to reasonable notice timeframe Date November 2012 November 2012 November 2012 Patient Access Policy V3 - November 2012 Page 1 of 11

Index Item no Page no 1. Introduction 3 2. Scope 3 3. Roles and Responsibilities 3 4. National Operating Standards 4 4.1 Patient entitlement to NHS treatment 4.2 Inappropriate referrals 4.3 Patients requiring commissioner approval 5. Outpatient Appointments 4 5.1 Reasonable notice 5.2 Appointment non-attendance (DNA) 5.3 Patient cancellation 5.4 Hospital cancellation 6. Diagnostic appointments 6 6.1 Reasonable notice 6.2 Appointment non-attendance (DNA) 6.3 Patient cancellation 6.4 Hospital cancellation 7. Pre-op assessment appointments 6 7.1 Appointment non-attendance (DNA) 7.2 Patient cancellation 7.3 Hospital cancellation 8. Elective admissions 7 8.1 Reasonable notice 8.2 Appointment non-attendance (DNA) 8.3 Patient cancellation 8.4 Hospital cancellation 8.5 Suspended waiting list 8.6 Patients listed for multiple procedures 8.7 Bilateral procedures 8.8 Planned waiting list 8.9 Tertiary referrals 9. War veterans 8 10. Exceptional circumstances 8 11. Departmental Standard Operating Procedures 8 12. Monitoring 8 Appendix A Safeguarding of Children and Young Adults not brought 10 For appointments (DNA s) Patient Access Policy V3 - November 2012 Page 2 of 11

1. Introduction The purpose of this policy is to ensure that all patients requiring access to outpatient appointments, elective inpatient treatment, elective day case treatment and diagnostic tests are managed consistently, according to national and local frameworks and definitions. The Policy is designed to ensure fair and equitable access to hospital and community services and the appropriate allocation of resources (beds, theatres, clinics, etc). The main determinant of when patients are treated is their clinical priority. Patients with similar clinical needs should be treated in chronological order. Timely regard should also be paid to National targets for access and any other mandatory requirements relating to patient access. To ensure effective use of resources local Commissioners may restrict the scope of services that are available to its population. Where Commissioners implement a change to services purchased, Stockport NHS Foundation Trust will amend access to these services accordingly. 2. Scope This policy aims to ensure that patients have their care planned and receive health care according to their clinical priority. This policy defines how patients should be managed if they do not attend an appointment or repeatedly cancel an appointment. It should ensure that no-attendance at an appointment is managed fairly and safely across the Health economy it serves. It supports the reduction in waiting times, cancelled appointments and the achievement of patient access targets. It relates to all patients referred into Stockport NHS Foundation Trust, regardless of the location of the actual appointment or treatment. Policy implementation applies to all staff managing patients under the care of Stockport NHS Foundation Trust, regardless of the actual location of the appointment or treatment. 3. Roles and Responsibilities Director of Operations To ensure policy implementation Associate Directors To ensure policy compliance within their areas of responsibility Clinicians To provide clinical judgement on further management of patients following a DNA or multiple patient cancellations. To comply with annual leave and study leave policies to ensure there is a minimum of six weeks notice. To effectively manage their waiting lists and patients waiting times in accordance with the maximum guaranteed waiting times. To ensure patients are not listed unless medically fit and ready for procedure. Business Managers / Operational Managers To ensure all staff within their area of responsibility are aware of the access policy and how it should be implemented within their individual roles. Waiting List Officers, Secretaries and Appointment personnel To manage patient pathways in accordance with the access policy. Patient Access Policy V3 - November 2012 Page 3 of 11

Referrers To ensure that referrals are appropriate, clear and contain the minimum data set required to process effectively and efficiently. 4.0 National Operating Standards The Trust will provide access to services and treatment within the defined timeframes as detailed in the NHS Operating Framework. The NHS Operating Framework can be located by the following link: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_1 31428.pdf 4.1 Patient entitlement to NHS treatment The Trust has a legal obligation to identify patients who are not eligible for free NHS treatment. The National Health Service provides healthcare for people who live in the United Kingdom. People who do not normally live in this country are not automatically entitled to use the NHS free of charge 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. All NHS Trusts have legal obligation to: Ensure that patients who are not ordinarily resident in the UK are identified. Assess liability for charges in accordance with Department of Health Overseas Visitors Regulations. Charge those liable to pay in accordance with Department of Health Overseas Visitors Regulations. Patient eligibility will be checked at first Outpatient attendance. 4.2 Inappropriate referrals Where a Consultant deems that a patient has been inappropriately referred, the GP will be advised as to the most appropriate management of the patient. 4.3 Patients requiring commissioner approval No referral for an excluded procedure will be accepted without an exceptional treatment approval form. If the referral does not have the relevant approval, the referral should be rejected and returned to the GP for them to request exceptional treatment funding via the relevant commissioning panel. In some instances it will not be apparent until the outpatient consultation that the patient requires an excluded procedure, when it is identified at the outpatient consultation the relevant clinician should refer the patient back to the GP for them to progress the exceptional treatment panel approval. 5 Outpatient appointments 5.1 Reasonable notice New and follow-up Outpatient appointments For a verbal offer to be deemed reasonable, the patient must be offered a minimum of two appointment dates on different days, with a minimum of two calendar weeks notice. For a written offer to be deemed reasonable, the patient must be offered an appointment date with a minimum two calendar weeks notice. Patient Access Policy V3 - November 2012 Page 4 of 11

Earlier dates can be offered if available and acceptable. Where patients are not given reasonable notice, they should not be discharged back to their GP. 2 week wait Cancer proforma referrals A verbal offer will be deemed reasonable if the patient is offered a minimum of one appointment with a minimum of two days notice. For a written offer to be deemed reasonable, the patient must be offered an appointment date with a minimum one calendar week s notice. 5.2 Appointment Non-Attendance (DNA) Providing reasonable notice of the appointment was communicated to the patient/carer, DNAs will be managed as follows: New patients Adult patients will be returned to the referrer if they DNA their first new outpatient appointment. 2ww Cancer proforma patients will automatically be sent a second appointment. If the patient subsequently DNAs this second appointment, the case notes will be reviewed by the lead Clinician and a decision on further management will be made ie refer back to GP. 2 week wait referrals can only be downgraded by the GP. If the Consultant thinks that the referral is inappropriate, this should be discussed with the GP and the GP asked to withdraw the 2 week referral status. Children and Vulnerable adults The doctor must consider whether there is a safeguarding risk if the patient does not attend, and then act accordingly in following any concerns up. It is their responsibility to liaise with the referrer to assess this risk and consider further actions if appropriate. Follow-up patients Routine Adult patients should be returned to the referrer. A further appointment will only be made if the treating clinician requires the patient to be seen. 2ww Cancer proforma patients the case notes should be reviewed by the treating Clinician and a decision on further management will be made ie refer back to GP Children and Vulnerable adults a clinical decision is made to either offer an alternative appointment or discharge back to the GP. This is left to the discretion and expertise of the Consultant/senior doctor provided that: It can be demonstrated that the appointment was clearly communicated to the patient ie correct demographics, contact information Discharging the patient is not contrary to the patients best clinical interests. There are no Safeguarding concerns (For further guidance on DNA s in children and young adults or any safeguarding concerns, please refer to Appendix A) 5.3 Patient Cancellations New and Follow-up patients If patients telephone to cancel and rearrange an appointment, a new appointment date should be agreed at the time. Patients will be referred back to their GP if they are unable to accept a reasonable offer of an alternative date. Patients who cancel two consecutive appointments, (having had reasonable notice of the appointment or previously agreeing the date), will be referred back to their GP. Patient availability If a patient cancels their appointment due to a long term medical condition which is unlikely to resolve in less than two weeks, then the patient Patient Access Policy V3 - November 2012 Page 5 of 11

should be discharged back to their GP. Likewise, If patients are unavailable for social reasons, then they should also be discharge back to their GP. Cancer pathway patients May only be referred back to their GP in agreement with the patient. 5.4 Hospital Cancellations A minimum of 6 weeks notice is required for any planned cancellation, reduction or changes. Clinic cancellations or reductions at less than 6 weeks notice will only be approved in an emergency or in exceptional circumstances. Where cancellations are initiated by the Trust, patients should be rebooked in a timely manner. 6 Diagnostic appointments 6.1 Reasonable notice A minimum of two weeks notice and one date should be applied to constitute a reasonable offer. Earlier dates can be offered if available and acceptable. Where patients do not agree dates within a reasonable timescale they should be discharged back to their GP. Where patients have not been given reasonable notice, they should not be discharged back to their GP. 6.2 Did Not Attend (DNA) The referring Clinician will be informed if the patient DNAs. No further appointment will be sent unless requested by the referrer following review of the medical notes. 6.3 Patient Cancellation The referring Clinician will be informed if the patient cancels two consecutive appointments, having had reasonable notice of the appointment or agreed the date. If patients do not re-appoint on the day of the cancellation, they will be returned to the referring Clinician 6.4 Hospital Cancellation A minimum of 6 weeks notice is required for any planned cancellation, reduction or changes. Appointment cancellations or reductions at less than 6 weeks notice will only be approved in an emergency or in exceptional circumstances. Where cancellations are initiated by the Trust, patients should be rebooked in a timely manner. 7 Pre- op assessment appointments 7.1 Did Not Attend (DNA) Patients will be removed form the waiting list and referred back to their GP. 7.2 Patient cancellation Patients who cancel two consecutive appointments, having had reasonable notice of the appointment or agreed the date, will be returned to their GP. If patients do not re-appoint on the day of the cancellation, they will be returned to their GP. 7.3 Hospital cancellation A minimum of 6 weeks notice is required for any planned cancellation, reduction or changes. Appointment cancellations or reductions at less than 6 weeks notice will only be approved in an emergency or in exceptional circumstances. Patient Access Policy V3 - November 2012 Page 6 of 11

Where cancellations are initiated by the Trust, patients should be rebooked in a timely manner. 8 Elective admissions 8.1 Reasonable notice A minimum of three weeks notice and one date should be applied to constitute a reasonable offer. Earlier dates can be offered if available and acceptable. Where patients do not agree dates within the reasonable timescale they should be discharged back to their GP. Where patients have not been given reasonable notice, they should not be discharged back to their GP. 8.2 Did Not Attend (DNA) Patients will be returned to the GP unless exceptional circumstances dictate otherwise. 8.3 Patient Cancellation If a patient cancels two admission dates, they will be removed from the waiting list and returned to their GP. 8.4 Hospital cancellations If an agreed admission date is cancelled by the hospital at any stage up to and including the day of admission, a new date should be agreed with the patient within seven days. If the operation is cancelled by the hospital on the actual day of admission, a new operation date will be given which should be within 28 days of the original operation date. 8.5 Suspended waiting list Patients who are deemed to be medically unfit for surgery for a period of more than 3 weeks, should be returned to their GP. Patients who are medical unfit for their procedure for a period of less than 3 weeks remain on the waiting list with no adjustment. Patients who are fit, but unavailable for social reasons for a period of less than 3 weeks, may be placed on the suspended waiting list Patients unavailable for social reasons for more than 3 weeks should be returned to their GP. 8.6 Patients requiring more than one listing for different conditions It is the Consultants responsibility to familiarise themselves with the patients medical condition and any other current listings that may affect the patients wait. For complex procedures, where it is unlikely that multiple procedures can be performed within the required timeframe, the patient should be returned back to the GP for monitoring until deemed fit and ready for a subsequent procedure. 8.7 Bilateral procedures The first operation should be added to a waiting list and linked to a pathway in the normal way. The second operation should be added to the waiting list but not linked to an 18- week pathway. The start date of the pathway for the second procedure will be the date the patient became fit and was ready for the second procedure. A new pathway will then commence 8.8 Planned procedures Patients on planned waiting lists will normally have had previous treatment and they are to receive a further planned course of treatment. Patients who are on the planned lists are not included in any calculation of the size of the waiting list because their procedures would not be done sooner if resources were not a constraint. Examples of procedures which should be on a planned list are: Patient Access Policy V3 - November 2012 Page 7 of 11

Patients waiting for more than one procedure where the procedures need, for clinical reasons, to be undertaken in a certain order. Check procedures such as cystoscopies, colonoscopies etc. Patients proceeding to the next stage of treatment ie: patients undergoing chemotherapy, or removal of metalwork. Staged surgery or bilateral procedures. The first stage of such procedures should be included on the normal waiting list, but all subsequent procedures are listed at follow up appointment which would commence with a new pathway. Sterilisation following pregnancy, when the procedure cannot be undertaken until after the pregnancy Patients on the planned waiting list will be managed in accordance with the clinically agreed timescales set by the Clinician. 8.9 Tertiary referrals Inter-provider transfer forms will be completed for any patient who is: Referred on to a tertiary provider Referred to a different Consultant within the Trust for the same condition. This is to ensure national compliance regarding provision of information for onward referrals 9.0 War veterans War veterans should receive priority treatment if the condition is directly attributable to injuries sustained during the war periods and for which they receive their war pension, as stated in DOH Directive HSG(97)31NHS Executive. The referrer must ensure that all relevant information is clearly communicated within the referral letter. 10.0 Exceptional circumstances Patients should not be penalised where exceptional circumstances prevent them from attending an appointment. Staff should exercise discretion in such situations, seeking guidance from their line Manager if required. However, certain circumstances may still arise whereby returning the patient back to the care of their GP would clinically be in their best interest and the safest course of action. These instances will be managed on an individual basis in discussion with relevant parties. 11.0 Departmental Standard Operating Procedures Standard Operating Procedures (SOPs) should be developed in each department to enable staff to implement and comply with the access policy in their area of work. SOPs should reflect national policy requirements and be updated as any change occurs. 12.0Monitoring Monitoring Arrangements Process for monitoring e.g. audit Responsible individual/ group/ committee Responsibility / Process / Frequency Patient pathway validation. PTL group Patient Access Policy V3 - November 2012 Page 8 of 11

Frequency of monitoring Responsible individual/ group/ committee for review of results Responsible individual/ group/ committee for development of action plan Responsible individual/ group/ committee for monitoring of action plan Daily validation by Information Team Selection of patients at weekly PTL meeting. PTL group PTL group PTL group APPENDIX A Patient Access Policy V3 - November 2012 Page 9 of 11

Safeguarding of Children and Young Adults not brought for appointments (DNA s) The final decision of whether to offer another appointment is based on the professional judgement of the Consultant/senior doctor. The reviewing doctor must document details of the record review and of the action to be taken in the patient s records. Referrals into the service from GP s or other professionals should clearly state if there are any Safeguarding issues within the family. This information should be considered by the Consultant when making decisions regarding offering a further appointment. The Paediatric service currently offers both letters inviting a child to an appointment but also a telephone reminder service. Consideration is given to ensuring that those with language or communication difficulties have adequate notice or appointments and support is available on the day. Professionals referring into the service should highlight any such issues to ensure the family are given the support they require to attend OPD. DNA s will be identified during the clinic session, and the notes reviewed by the Consultant/senior doctor (middle grade or equivalent) at this time. Consideration must be given to the following: o o o o o Urgency of the referral Significance of clinical information provided in the referral letter Any existing Safeguarding concerns in the family Any other mitigating circumstances Future appointments with the service The doctor must then to consider whether there is a safeguarding risk in the non attendance and then act accordingly in following any concerns up. It is their responsibility to liaise with the referrer to assess this risk and consider further actions if appropriate. (see section below on non engagement where the child is at risk) A letter detailing the DNA appointment details should be sent to the referring GP or Health Professional with a copy to the Health Visitor or School nurse (dependent on child s age). This letter should clearly state what action the GP is expected to take in response. Certain groups of children are particularly vulnerable and therefore need special consideration. These include; o Children under 12 years old o Those known to social care/on a child protection plan o Those on medication o Children/YP with mental health problems o Children with long term conditions where close monitoring is vital to improved outcomes. E.g. Diabetes, Cystic Fibrosis, Cardiac conditions. o Children with a disability o Travelling families/those seeking asylum and the homeless. With persistent DNAs the practitioner should contact other professionals involved with the family to establish whether the child is engaging elsewhere. This is especially relevant where the child or family is particularly vulnerable and has a long term health condition. E.g. School, Health visitors, GP etc. (LSCB Roles and Responsibilities Section 2.27 Stockport LSCB handbook) Patient Access Policy V3 - November 2012 Page 10 of 11

If families refuse or persistently fail to attend appointments and there is sufficient concern, practitioners should contact Social Care to make a referral this should be verbal and followed up in writing within 48 hours. If the baby, child or young person is discharged: A letter is sent to the GP stating the reason for discharge The opportunity for the GP to re-refer back to the Consultant. A copy of the discharge letter and any DNA letters are sent to the Health Visitor or School Nurse (dependant on child s age). It is also advisable to send a copy to parents/carers of the child or young person. For follow up patient DNA s a clinical decision is made to either offer an alternative appointment or discharge back to the GP. This is left to the discretion and expertise of the Consultant/senior doctor provided that: It can be demonstrated that the appointment was clearly communicated to the patient i.e. correct demographics, contact information. Discharging the patient is not contrary to the child s best clinical interests. There are no Safeguarding concerns (see below). DNA s where the child/family are subject to a child protection plan or Looked after children. For children who are subject to a child protection plan, any non engagement should be reported as soon as possible to the family social worker. Staff should inform the Trust Safeguarding team of their concerns via a Cause for Concern stating the details of the referral to social care. All actions should be documented fully in the child s health/medical record. An alternative appointment should be offered within the shortest possible time and this communicated clearly to the family by letter and via a telephone reminder. A copy of this should be sent to GP, HV/School Nurse and Social Care. Patient Access Policy V3 - November 2012 Page 11 of 11