Policy No: OP12
Version: 7.0
Name of Policy: Patient Access (Waiting List/Waiting Times)
Policy
Effective From: 18/04/2018
Date Ratified 27/03/2018
Ratified Finance and Performance Committee
Review Date 01/03/2020
Sponsor Director of Strategy and Transformation
Expiry Date 26/03/2021
Withdrawn Date
Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no
assurance that this is the most up to date version
This policy supersedes all previous issues
Patient Access (Waiting List/Waiting Times) Policy v7 2
Version Control
Version Release Author/Reviewer Ratified
by/Authorised
by
Date Changes
(Please identify
page no.)
1.0
2.0
June 2006 Trust Policy
Forum
June 2006
3.0 March 2007 BSDC March
2007
4.0 Aug 2008 BSDC Aug 2008
5.0 17/12/2009 Steve Atkinson
Sharon Pearson
BSDC 05/10/2009
6.0 27/02/2014 Julie Rush Patient,
Quality,Safety &
Risk Committe
17/01/2014
7.0 18/04/2018
Julie Rush/Denise
Reay/Steve
Lawson
Finance and
Performance
Committe
27/03/2018
Full review
following internal
audit, updated
guidance and
recommendations
from NHSI/NHSE
access policy
master class
Patient Access (Waiting List/Waiting Times) Policy v7 3
Contents
Section Page
1 Introduction ...................................................................................................................... 4
2 Policy scope ....................................................................................................................... 5
3 Aim of policy...................................................................................................................... 7
4 Duties (Roles and responsibilities) .................................................................................... 7
5 Referral Management ....................................................................................................... 9
6 Appointment Management .............................................................................................. 10
6.1 Appointment Booking Management
6.2 Capacity and appointment slot issues
6.3 Patient cancellations
6.4 Clinic attendance
6.5 Clinic outcome
6.6 Did not attend
6.7 Patient Transport
6.8 Clinic administration
6.9 Clinic format
6.10 Clinic change management
6.11 Outpatient waiting list validation
6.12 Management of Inpatient & Daycase waiting list
6.13 Treatment management
6.14 Inpatient & Daycase cancellations and suspensions
6.15 NHS Constitution/Patient Choice
7 Training ............................................................................................................................. 22
8 Equality and diversity ........................................................................................................ 22
9 Monitoring compliance with the policy ............................................................................ 22
10 Consultation and review .................................................................................................. 23
11 Implementation of policy (including raising awareness) .................................................. 23
12 References......................................................................................................................... 23
13 Appendices ........................................................................................................................ 24-51
Patient Access (Waiting List/Waiting Times) Policy v7 4
Patient Access (Waiting List/Waiting Times) Policy
1. Introduction
This Policy is issued and maintained by the Director of Strategy and Transformation on behalf of The
Trust, at the date identified on the front sheet, which supersedes and replaces all previous versions
This is the Trust Patient Access (Waiting List/Times) Policy (OP12) for Gateshead Health NHS
Foundation Trust. The document has been developed with consultation throughout the local health
community and supports the NHS Plan. This has included partnership working across the whole Health
Community
The successful management of patients who wait for all appointments and elective treatment is the
responsibility of a range of staff working within all sectors of the NHS, including Trust staff,
Commissioners, GP and patients. Service commissioners must ensure that service agreements are
established with sufficient capacity to ensure that no patient waits more than the guaranteed
maximum time specified in the NHS Plan. Hospital medical staff, managers, secretarial and clerical staff
all have an important role in treating patients delivering a high quality, efficient and responsive service
and managing waiting lists effectively
This policy is a reference document which applies to the management of all waiting lists held by
Gateshead Health NHS Foundation Trust – inpatient, day case, outpatient, therapy and diagnostic
services and must be adhered to by all staff. The policy will be available to all those involved in
organising access to the Trust’s services including the general public
It is the Trusts intention to continue to modernise its outpatient and inpatient treatment management
systems in line with the NHS Plan. A range of booking systems have been developed to support this.
National developments such as NHS e-Referral Service and local systems such as ICE Pathology and
Radiology requesting tools have been rolled out in collaboration with General Practitioners, CCGs and
Trust clinical and administrative staff.
The NHS Constitution came into effect 1st April 2010 and sets out the following rights for patients:
• The NHS is making sure that you are seen as soon as possible, at a time that is convenient for
you. To do this, the NHS Constitution gives you the right to access services within maximum
waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable
alternative providers if this is not possible
• This right is a legal entitlement protected by law, and applies to the NHS in England from 1st
April 2010. The maximum waiting times are described in the Handbook to the NHS
Constitution which you can find on our website. Gateway reference: 13676
www.Gatesheadhealth.nhs.uk/constitution
If any staff member has any queries regarding this policy they should contact their immediate line
manager in the first instance.
There may be occasions when situations arise which are not covered by this document. In such
circumstances the appropriate line manager should be contacted. If further advice is required,
guidance should be sought from the Business Unit, Associate Director or Departmental Manager for
that service.
The features in this policy are consistent with advice given in:
• NHS Improvement Plan
• Tackling Hospital Waiting: the 18 week pathway and Implementation Framework
Patient Access (Waiting List/Waiting Times) Policy v7 5
• RTT Consultant –led watiting time Rules Suite Oct 2015
• NHS Constitution Access to Services – October 2015
• Delivering Cancer Waiting Times – A Good Practice Guide
Trust Commitment
The aim of this health community is to provide good access to high quality healthcare and Gateshead
Health NHS Foundation Trust is committed to the following:
• All patients will be treated according to clinical need within the resources available
• To establish a consistent approach to patient access across Gateshead
• An integrated and sustained approach to waiting list management
• Systematic approach to developing referral protocols and guidelines with GP’s,underpinned by
regular audit to monitor effectiveness
• Effective two way communication with patients and their GP
• Quality of information both internally and externally
• Continual improvement in the effectiveness and efficiency of current services dependent upon
resources; and
• Pooling of an agreed range of procedures between consultants. The Trust will state its
responsibilities for access times and patient information. Similarly patient responsibilities will
be clearly identified
2. Policy scope
2.1 The Business Unit Associate Directors, Managers and Departmental Heads for all business units
are responsible for ensuring that the policy is effectively implemented through the Business
Unit management structure and for reviewing the policy on an annual basis.
2.2 All OPD booking areas and reception areas will carry out periodic audits to ensure compliance
with the Policy. Audit outcomes will be shared at the Data Quality Strategy Meetings.
2.3 The Director of Finance and Information has the responsibility for ensuring that mechanisms
are in place to enable the Trust to collect data accurately and ensuring that systems are
available to do so
2.4 The policy and subsequent amendments will be approved by the Finance and Performance
Committee, Clinical Policy Group for clinican sign off, and the CCG. The policy will also be taken
to a public meeting of the board.
2.5 The Business Unit Associate Directors and Managers along with the Departmental Operational
Managers have the responsibility to ensure that patients are monitored and managed in
accordance with this policy and the procedural guidelines, which underpin the policy
2.6 The clinical management of individual patients on the waiting list is the responsibility of the
clinician in charge of the patient’s care
2.7 GPs/referrers have a responsibility to provide accurate and complete information within
referral letters, use referral templates where available and identify any patient special needs
(including war pensioners). To minimise waits and maximise access, GPs/referrers are
encouraged to make pooled/open referrals to a clinical specialty/sub-specialty.
2.8 Patients are responsible for complying with booking arrangements, attending appointments
and ensuring that the Hospital is informed of any relevant changes in circumstances
Patient Access (Waiting List/Waiting Times) Policy v7 6
Key Principles
As a Trust which promotes diversity and inclusion, both as an employer and service provider, the Trust
will:
• Support staff in providing the best possible quality of care to patients, and to treat patients,
carers, and relatives with dignity and respect, taking into account issues, interpretations and
where possible, the specific needs of people from different race, faiths, cultures, genders and
people with disabilities
• Ensure that staff develop an awareness of policies to promote equality and of the legislative
requirements affecting patient groups
• Review practices and procedures to ensure that services are accessible
• Ensure reasonable adjustments are made where necessary to accommodate the needs of
people from different race, gender and people with disabilities
• Have robust plans developed in collaboration with the CCG and wider health economy to
achieve and maintain access standards/waiting times set by the Department of Health/NHS
Improvement.
• Ensure the management of patients on waiting lists will be equitable and transparent
• Ensure patients are treated in relation to their clinical need and in accordance with their rights
to timely treatment as specified in the NHS Constitution
• Add patients to a waiting list if they are clinically deemed fit to have their operation within the
maximum waiting time guarantee
• Offer patients choice of appointment and admission date within a reasonable time
• Ensure patients of the same clinical priority will be offered dates for treatment in chronological
order with the exception of patients showing flexibility to accept short notice appointments
due to short notice cancellations
• Referral guidelines will continue to be developed alongside systems to feedback on
appropriateness of referrals; for services and those who make referrals
• Have appropriate and effective booking systems across all specialties
• Communication with patients at all stages should be informative, timely, unambiguous and
concise
• All policies, procedures and performance information will be made widely available, including
to the general public (unless there is a specific reason for restricted availability)
• Accurate and up to date information about the outpatient and direct access services provided
by the Trust will be included on the NHS e-Referral Service, Directory of Services (DoS)
• The Trust will offer outpatient appointments to ensure that there is availability for new
referrals to be seen in a timely mannerand to ensure the hospital remains on the “choice”
menu for local referring GPs
National Waiting Times Standards
The Trust is required to achieve the waiting time standards stated in the NHS Constitution and detailed
in the NHS Consitution handbook. For more information on the NHS Constituion and the detail of the
waiting time standards please click on the links below:
https://www.gov.uk/government/publications/the-nhs-constitution-for-england
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/474450/NHS_Consti
tution_Handbook_v2.pdf
Key National access targets associated with the waiting time standards are frequently reviewed and
can be found in the most recent versions of the NHS Single Oversight Framework in the link below:
https://improvement.nhs.uk/resources/single-oversight-framework/
Patient Access (Waiting List/Waiting Times) Policy v7 7
Wherever possible the published National Waiting Times Guidelines on reasonableness for written and
verbal offers of appointments and admission offers will be followed (Appendix 2).
3 Aim of policy
3.1 The length of time a patient waits for hospital treatment is an important quality issue and is a
visible and public indicator of the efficiency of the hospital services provided by the Trust
3.2 The successful management of patients who are waiting for elective treatment is the
responsibility of a number of key individuals and organisations including Clinical Commissiong
Groups, General Practitioners, Hospital Doctors, and Trust Managers. If patients who are
waiting for appointments or treatment are to be managed effectively it is essential for
everyone involved to have a clear understanding of their roles and responsibilities. Patients
also have responsibilities for complying with the booking systems in place.
3.3 This policy defines those roles and responsibilities and establishes good practice guidelines to
assist staff with the effective management of outpatient and inpatient waiting lists. Data
quality is the responsibility of all involved in the care pathway including clinical staff, service
management and administration. The assurance of data quality and coordination of required
improvement actions is the responsibility of the Trust’s Head of Information and Data Quality.
3.4 Data capture, processing and reporting must accurately reflect working practice and be in
accordance with the data principles contained in the Data Protection Act (1998)
3.5 The Trust will manage data quality issues as per the Data Quality Strategy –
http://pandora/docs/policies/DOCUMENTS%20POLICIES/Forms/Information%20Gov
ernance%20Policies.aspx?View={f3c35920-45bf-44e3-873b-
0a73a1f6b3f1}&SortField=LinkFilenameNoMenu&SortDir=Asc
3.6 This policy applies to all waiting lists managed by Gateshead Health NHS Foundation Trust
including inpatient, day case, outpatient, therapies and diagnostic services.
4 Duties - roles and responsibilities
The application and implementation of this policy is the responsibility of all staff and services relating to
patient access managed by Gateshead Health NHS Foundation Trust. All staff involved in the
management of patients’ access to services within the organisation are expected to follow this policy
and associated operating procedures.
Trust Board
Responsible for ensuring there is a robust system of Corporate Governance within the organisation.
Chief Executive
Ultimately responsible for ensuring effective corporate governance within the organisation and has
overall responsibility and accountability for delivering access targets as defined in the NHS plan, NHS
Constitution and NHSI Improvements Single Oversight Framework.
Director of Finance and Information
Will ensure that systems and mechanisms are in place to enable the Trust to capture data accurately
and the appropriate reports are compiled and distributed on a regular basis to facilitate patient care is
delivered within the standards set in the NHS constitution.
Patient Access (Waiting List/Waiting Times) Policy v7 8
Head of Information and team
Produce regular operational reports to monitor waiting times, Patient Tracking Lists (PTL’s) and
dashboards on the delivery of the 18 week Referal to Treatment (RTT), Cancer and Diagnostic waiting
times. Provide support to ensure high data quality, including standard operating procedures and
appropriate training, and provide assurance of the data quality of key indicators.
Systems Manager and System Administrators
Provide initial and ongoing systems and RTT training when changes to guidance or systems occur
ensuring training records are kept up to date. Provide ongoing advice and support staff within Business
units on RTT standards, queries and issues.
Head of Performance and team
Work with business units to manage delivery of access standards and providing analytical support to
do so (e.g. capacity and demand analysis). Provide Trust-wide management of risks to the delivery of
national access standards with regular reporting to CMT and the Board.
Service Line Managers (SLM)
Will be responsible for overseeing the operational management of waiting lists to ensure the principles
outlined in the policy are applied.
Will ensure overall capacity meets inpatient, outpatient, daycase and diagnostic demand within the
constraints of the waiting time targets , service level agreements and contracting levels linked to
consultant job plans
Clinicians
Will be responsible for the timely review or triage of referrals and diagnositic requests received into
the Trust in accordance with the policy timescales (where review is determined appropriate by the
service), ensuring cover arrangements are in place when clinicians are unavailable due to annual leave
commitments.
Support Service Line Managers with capacity and demand planning to ensure all patients are seen
within the agreed local and national access standard waiting times.
Ensure 6 weeks notice is given prior to the cancellation of any outpatient, inpatient and diagnostic
activity and provide alternative dates to reduce impact service delivery.
Ensure completion of clinic outcome slips capturing appropriate RTT status and outpatient procedure
coding.
Waiting List Managers, Adminstration Managers and Secretaries
Each business unit will have members of staff that will have direct involvement or responsiblity in
monitoring and tracking of patients through RTT pathways. This will be determined at speciality level
and SLMs will be responsible for ensuring the staff group provide the following:
• Manage waiting lists and patient pathways in line with waiting time standards, liaising closely
with clinicians, SLMs and the centralised booking team to ensure all patients are accounted for
and booked appropriately, through ongoing review.
• Ensure referral contracts are added within 24 hours of receipt if received directly into
secretary/consultant offices instead of centralised booking team to ensure RTT pathway start
dates are recorded and tracked as soon as possible
Patient Access (Waiting List/Waiting Times) Policy v7 9
• Proactively monitor capacity and demand highlighting capacity shortfalls timely to SLMs and
clinicians to avoid waiting times being compromised and ensure choice of dates are available
within deemed reasonable notice period for type of referral ( ie urgent, routine).
• Validate patient pathways to ensure activity and waiting times are accurate in line with current
national guidance.
• Attend 18week RTT tracking meetings and Data Quality Strategy meetings
Appointments Managers/ administrators
• Will ensure all referrals received into the Referral and Booking Management Centre are
processed timely and appointments booked according to clinical prioirity and/or chronological
order using QM08 reporting tools.
• Will highlight capacity shortfalls to the relevant waiting list manager as soon as apparent using
daily Appointment Slot Issues notification and 2ww reports in the first instance.
Reception staff/ward staff
• Will ensure all patients attending are recorded correctly on PAS systems, using Postive Patient
Safety ID checks.
• Will update outcomes and RTT status where required (or discharge or transfer) on day of
attendance/discharge or within 24 hours if activity takes place out of core working hours.
• Arrange follow up at the direction of the clinician following attendance
GPs and Clinical Commissioning Groups
GPs and Clinical Commission Groups have a pivotal role in ensuring patients are made aware during
their consultation of the likely waiting times for a new outpatient consultation and the need to be
contactable and available when referred. The CCG will be responsible for ensuring robust
communication links are in place to feed back information to GPs.
5 Referral Management
5.1.1 The Trust’s preferred referral route for GP referrals is via the NHS e Referral Service and this is
the mandated route for receipt of all referrals to consultant led services from October 2018 as
outlined in the variation to the NHS Standard Contract 2017-19 6.2A. Where services are not
available, paper referrals (i.e. email, fax, post) should be received by the Referral & Booking
Management Centre. However it is recognised that it may be appropriate for some referrals
to be sent directly to individual business units or services.
5.1.2 A new referral must be made for a patient with an existing condition if the request for futher
consultation is 6 months after the discharge of the original referral unless the patients has
been given a time specific SOS appointment.
5.1.3 Referrals and requests should be triaged within 3 working days of receipt, where possible using
the Windip Workflow module, e-Referral service or Carestream and returned to the Referral &
Booking Management Centre for processing. Business units must work with consultants to
ensure that here are contingency arrangments in place to cover periods of consultant annual
leave, study leave and sickness to prevent delays in triage. Where services are offering Advice
& Guidance through NHS e-Referrals a response must be provided to the referring GP within 5
working days as per contractual agreements.
Patient Access (Waiting List/Waiting Times) Policy v7 10
5.1.4 GP referrals for consultant led services received outside of the NHS e-Referral Service by
services should be sent immediately to the Referral & Booking Management Centre to enable
the appropriate returns process to be initiated as per the variation to the NHS Standard
Contract 2017-19 6.2A. All other referrals received directly into services (consultant offices)
should be date stamped, added to the relevant PAS system and triaged on receipt. Referals
should then be sent electronically using agreed internal mailboxes and/or systems to the
Referral & Booking Management Centre to process where appropriate.
Cancer Referrals
5.1.6 The quality of suspected cancer referrals will be subject to regular review within the clinical
teams with appropriate feedback to the GPs and CCGs.
5.1.7 GP’s will be encouraged to clearly identify referrals which are suspicious of cancer by use of
standardised tumour specific referral proformas recommended by NICE and regional Cancer
Network Groups (Cancer Operational Policy OP90).
5.1.8 Rapid access facilities exist for receiving cancer referrals via the NHS e-Referral service or an
indentified fax or NHS.net account following agreed security protocols. Timely dispatch of
referrals to these faciliites will ensure the fast tracking of appointments as well as avoiding
duplication.
5.1.9 Patients who are referred with suspected cancer must be seen within 14 days of the receipt of
referral and offered 2 dates within this period.
5.1.10 Patients should have a maximum 1-month wait from diagnosis (date of DECISION TO TREAT) to
first definitive treatment for all cancer (31-day target) and a maximum 2-month wait from
urgent GP referral for suspected cancer to first definitive treatment for all cancers (62-day
target). Cancer waiting targets: Guide – Version 8
Tertiary Referrals/ Consultant to Consultant (C2CR)
5.1.11 The Newcastle and Gateshead CCG, C2CR Policy states that to allow choice and treatment to
be provided by the best placed clinician, secondary care clinicians should not refer directly to
internal colleagues except in specific circumstances described below. Instead they should write
to the GP and/or originating referrer to advise on appropriate treatment and further
management. Many conditions can be managed by the skills available in primary care and do
not require secondary care input until these have been completed. Letters back to primary
care may be used as the onward referral letter if they agree that an onward referral is needed
so secondary care teams are asked to include any detail a future specialist may need. The full
policy is available in appendix 3.
6. Appointment Management
6.1.1 All outpatient and diagnostic appointments will be managed on the appropriate patient
administration system and information regarding the status of the appointment recorded at
every opportunity (appointment declined, cancelled and appropriate reasons).
6.1.2 All patients will be booked according to clinical priority. Patients of the same clinical priority
will be offered appointment dates for treatment within chronological order with the exception
of patients showing flexibility to accept short notice and utilisation of appointment slots due to
short notice cancellations.
Patient Access (Waiting List/Waiting Times) Policy v7 11
6.1.3 The Trust will endeavour to contact patients to verbally agree a date and time for those
patients requiring short notice appointments (within 14 days). Attempts will be made over the
course of a working day up until 8pm. If the patient cannot be contacted the appointment will
be booked and a confirmation letter will be generated from the appropriate booking system
providing details how to rebook if the date is inconvenient.
6.1.4 For an written appointment or admission to be deemed reasonable, the patient is to be
offered a date with a minimum of 3 weeks notice. In addition to the 3 weeks notice, for a
verbal appointment or admission offer to be deemed reasonable the patient is to be offered a
minimum of 2 different dates. (DSCN07/2003 guidance Appendix 2). This does not apply to
patients offered short notice appointment due to clinical need.
6.1.5 Referrals generated from HM Prisons will receive a fixed appointment and this will always be
addressed to the Medical Officer of the prison establishment. Security will be informed that a
prisoner will be on site to liaise with Prison Service where required.
6.1.6 Appointments for patient’s requiring interpertering services will receive a fixed appointment
with details of how to rebook, in the preferred language where possible.
6.1.7 All appointment letters will have details of the contact numbers for patients requiring
additional support with their appointment (easy read information etc.,)
6.1.8 In the event of the Trust having short notice availability, this will be offered to patients but
non-acceptance will not compromise the patient’s position in terms of the reasonableness
criteria as stated above.
6.1.9 The NHS e-Referral Service enables patients to fully book directly into a consultant’s outpatient
clinic at the time the decision to refer is made (i.e. at the GP practice). Patients can also book
at a later date via The Appointments Line (TAL) or on-line via the HealthSpace website:
https://www.healthspace.nhs.uk
6.1.10 War pensioners should receive priority treatment, both as Outpatients and Inpatients with the
condition(s) for which the war pension has been given (Appendix 4 )
6.1.11 Military veterans should receive priority access to NHS secondary care for any conditions
which are likely to be related to their service subject to clinically needs of all patients
(Appendix 4)
6.1.12 Patients who fail to respond to an appointment offer within the required timescales (partial
booking processes) will have their referral letter returned to the referring clinician
6.2 Capacity and appointment slot issues (ASIs)
6.2.1 Where patients cannot be allocated an appointment or where slots are no longer available
within the NHS e-Referral Service within the agreed waiting time, due to unavailability of clinic
slots, the appropriate Service Line Managers, Associate Directors and Waiting List manager
will be informed. Patients will be contacted by telephone or sent an acknowledgement letter
(Receipt of Referral) to let them know their request for an appointment has been received by
the trust.
6.2.2 The Referral and Booking Management Centre will send the following reports :
• Daily Appointment Slot Issues reports showing patients unable to directly book
Patient Access (Waiting List/Waiting Times) Policy v7 12
• Daily 2ww Cancer DQ report showing patients referred on the 2ww Cancer pathways who are
unable to directly book due to capacity issues or who have booked beyond 14 days to enable
business units to manage individual patients.
• QM08 report showing all referrals that require an appointment booking (minimum weekly or
as required)
6.3 Patient cancellations (CNA)
6.3.1 If the patient has never been seen and advises they do not wish to progress their pathway,
they will be removed from the relevant waiting list and a clock stop and nullification applied.
The patient will be informed that their consultant and GP will be informed of this.
6.3.2 Patients who cancel their first new appointment should be given an alternative date at the
time of cancellation. Patients originally referred on a 2ww cancer referral must be given a
further appointment within 14 days.
6.3.3 Patients who have cancelled and/or rebooked their appointment more than twice will be
monitored by the Business Unit using the Multiple Consecutive Cancellations Report available in
the Business Intelligence Suite. Having been identified the patient should be subject to a
clinical review within the Business Unit and may be discharged back to the GP if it is clinically
safe to do so or offered a further appointment date.
6.3.4 The appointment confirmation letter will clearly state that should a patient cancel their
appointment twice they may be discharged back to their GP under the process described in
6.3.3.
6.3.5 Patients referred on the 2ww fast track pathway will not be routinely re-appointed following a
second cancellation. An appropriate member of staff nominated by the business unit will
contact the patient to establish the reasons for cancellation. If the patient refuses to keep an
appointment and is unable to co-operate within a reasonable time frame then the
conversation between the Trust and the patient will agree that a return to the GP care is the
most appropriate course of action. A standardised 2ww CNA letter will be generated from the
appropriate booking system and sent to the GP within 48 hours of the decision.
6.3.6 If the patient is unable or refusing to co-operate within a reasonable time frame and this
remains unresolved the patient will be informed by the Business Unit that a letter of non/or
delay appointment will be sent to the advise the GP. A letter from the consultant will inform
the GP of the reason given for a requested delay by the patient. This letter will be sent within
48 hours of contact with the patient for the GP to decide if the patient should be downgraded
from the 2 week wait referral pathway.
6.3.8 If a new or follow up patient informs the Trust that they cannot attend as they have been
admitted as an inpatient to a hospital, the administrator taking the call will inform the relevant
consultant of the circumstances and seek advice as to further action required. Locally agreed
process within the specialities and departments should be in place.
6.4 Attendance at Clinic
6.4.1 On arrival at the appointment, the reception clerk will check to ensure that the details
recorded on the pre-registration form are checked and amendments made on the appropriate
system if required. To ensure compliance with national standards for data collection. If the
patient fails to bring the pre-registration form, Postive Patient ID checks will be made at that
time.
Patient Access (Waiting List/Waiting Times) Policy v7 13
6.4.2 For patients who have identified that they have not lived in the UK for the past 12 months the
Finance Department should be contacted immediately. Further guidance can be found in the
Treatment of Overseas Visitors & Asylum Seekers Policy OP11b.
http://pandora/docs/policies/DOCUMENTS%20POLICIES/Forms/Operational.aspx
6.4.3 Where possible, diagnostic tests should be carried out and results made available before or
during the patient’s attendance at outpatients to reduce the number of visits and
inconvenience caused to patients.
6.4.4 As identified by medical staff, all patients who attend outpatient/endoscopy clinics will have
their outcomes recorded in their health records and on the PAS system.
6.4.5 Clinic outcome slips should be completed by the clinician in clinic identifying status of the RTT
pathway and any outpatient procedures that have been carried out at that attendance. The
reception clerk will then transpose this information into the relevant system to ensure RTT
timescales can be monitored accurately.
6.4.6 Patients attending the Endoscopy unit for procedures will be recorded as inpatient activity in
the Endoscheduler with the exception of Urology patients. These patients will be recorded
initially on PAS as an outpatient, enabling the Trust to continue to receive referrals via NHS e-
Referral service. For the episode to be recorded accurately on the day of the procedure this
will be recorded on PAS as an inpatient episode. The Trust booking teams will remove the
outpatient episode and ensure the inpatient episode is captured. Local SOPs will be in place
within the Endoscopy Unit and the Referral & Booking Management Centre to support this
process.
6.4.7 Arrangements for follow up care will reflect the need to minimise the long-term surveillance
follow-up in preference for an early referral back to primary care; and where
appropriate/suitable the follow-up care will be provided by an alternative professional i.e.
specialist nurses/technical staff.
6.4.8 All follow up patients will be offered choice of appointment and venue at the time of leaving
the clinic if the patient is to return to the Outpatients within 12 weeks or via a partial booking
process where appropriate.
6.4.9 Where it is necessary to issue a patient with an ‘Open’ Out-Patient Follow-up Appointment
(SOS), the patient will be advised of the timescales in order to re-access the system and this
will be noted on the PAS system.
Urgent Inpatient follow up/Discharge Appointments
6.4.10 Wards will liaise with the relevant booking team to agree an appointment date, time and
venue on behalf of the patient.
Routine Inpatient Follow-up/Discharge Appointments
6.4.11 Wards will e-mail requests to relevant booking team with relevant instructions. The booking
team will then contact patient to agree a sutiable appointment.
6.4.12 All suitable patients will be contacted by the Trust Remind/Confirmation service 4-7 days in
advance of their planned appointment and will be asked to confirm their attendance, cancel or
re-arrange their appointment. Patients are given the choice to opt out of this service if they do
not wish to receive a remind/confirmation call. Patients may receive an automated call, SMS
message or agent call depending on service agreements.
Patient Access (Waiting List/Waiting Times) Policy v7 14
6.5 Clinic Outcome Management
6.5.1 It is the responsibility of the medical staff in clinic to ensure that all patients have a clinic
outcomes instruction slip completed at the end of their consultation.
6.5.2 The outcome will indicate attendance, procedures performed in clinic and subsequent actions
with timescales required (ie follow up, diagnostic appt, discharged).
6.5.3 All patients booked into a clinic will have an outcome recorded on PAS against their
attendance.
6.5.4 The information given on the outpatient clinic instruction slip will be recorded on PAS within
24 hours of the patient’s attendance at clinic or as soon as practically possible for domiciliary
clinics.
6.5.5 Written communication in the form of outpatient clinical letters will be sent to the GP/referrer
and patient, from the clinician within 10 working days of the clinic (Copying clinical letters to
patients policy OP18).
6.6 Patients who do not attend an outpatient appointment (DNAs)
Please note, the below processes are the minimum standards that will be expected across services.
Locally some services will have additional steps depending upon clinical pathways. Where this is the
case those services will be responsible for managing this process.
6.6.1 Non-attendees (DNAs) are patients who fail to attend and provide no advanced explanation or
warning.
6.6.2 Appropriate administrative checks should be undertaken to ensure that patient details are
accurate and up to date.
6.6.3 Patients who DNA their 1st new appointment will be invited to contact the Trust to rebook
their appointment within an agreed timeframe (Appendix 5). This excludes cancer and
children’s referrals where relevant legislation overrides this.
6.6.4 If the patient fails to respond in the agreed timeframe the patient will be discharged and
removed from the Outpatient Waiting list. The patient and referring clinician (including patient
GP where they are not the referring clinician) will be sent an explanatory letter .
6.6.5 Patients who DNA a second new appointment, will be discharged and removed from the
Outpatient Waiting list. The patient and referring clinician will be sent an explanatory letter.
The letter will give the GP the option of re-referring to request a further appointment.
6.6.6 Patients who have been referred via the two week wait referral pathways must be
reappointed within two weeks. (Cancer Operational Policy OP90)
6.6.7 Patients referred on a 2ww referral pathway who have multiple DNA’s/cancellations (2 or
more) will be contacted by an appropriate member of staff nominated by the business unit to
identify any factors that may be stopping the patient attending. Another appointment will be
offered if the patient agrees. Patients can be discharged back to the GP after multiple
DNA’s/cancellations (2 or more) if this has been agreed with the patient.
Patient Access (Waiting List/Waiting Times) Policy v7 15
6.6.8 Patients who do not attend a follow up appointment may be offered a further appointment at
the consultant’s discretion. Given the potential child protection issues around the non-
attendance of children, this system will also apply to paediatric patients.
6.6.9 If a patient DNA’s their first appointment and a second appointment is offered, the reported
waiting time will be from the date that the patient agrees the new appointment date (RTT
Rules Suite October 2015).
6.7 Patient Transport
6.7.1 A patient is only eligible for provision of transport (PTS) providing they meet the eligibility
criteria. The Trust is not responsible for the decision making within this process and patients
will have the right to appeal. See PTS Eligibility Criteria –FAQ (Appendix 6)
6.7.2 New and follow up patients or their advocates are required to contact NEAS directly where
they will be assessed to determined if the patient fits the criteria.
6.7.3 When patients have transport booked, the ambulance service must be notified of any
amendments to the patient’s appointment by the patient themselves as indicated in the
patient’s appointment letter.
6.7.4 Any patient who arrives for their clinic appointment by patient transport up to 20 minutes
beyond their planned appointment time will be seen in clinic as soon as possible but made
aware that they may be required to wait until the end of clinic. Patients should not be sent
away without being seen.
6.7.5 Reception staff will ensure NEAS are informed when the patient is ready to be collected.
6.8 Clinic Administration
6.8.1 Clinicians, Associate Directors, or a designated person should review booking rules on an
ongoing basis in line with the Consultant Job Plan to ensure that they remain relevant both to
the needs of clinical practice as well as waiting list management. Any changes to clinic
arrangements must be agreed with the Associate Director.
6.8.2 The rules governing the booking of outpatient appointments should be established by the
clinician responsible for the clinic in consultation with the Associate Director and Service Line
Manager and must ensure that all new patient slots are released to NHS e-Referrals Service for
all consultant led services as per national guidance (CQUIN).
6.9 Clinic Formats
6.9.1 The following booking rule management applies to all clinic formats;
• Set type and number of slots available on each clinic (format)
• Set amount of consultation time available which informs capacity and demand management
• Should take into account the number of clinical staff undertaking the work including clinical
nurse specialists and other professions
• Identify the specialty codes and treatment codes required
• Inclusion in the reminder/confirmation service
6.9.2 Booking rules should reflect appropriate levels of capacity for new and follow-up
consultations. Variances in new to follow up numbers should be monitored by Associate
Directors.
Patient Access (Waiting List/Waiting Times) Policy v7 16
6.9.3 Clinic utilisation and productivity will be regularly monitored by the Associate Directors and
should plan and regularly undertake a systematic analysis of performance against:
• Start/finish times
• Fully booked
• New to follow-up ratio
• Productivity
• DNA and cancellation rates
• Conversion of outcome (demonstrates effectiveness of the clinic by patient outcome),
including conversion rate and discharge
• Information given to patients
6.9.4 Booking rule configuration will be agreed with the Service Line Managers and the Associate
Directors in agreement with each consultant and Business Unit.
6.9.5 Wherever possible, generic booking rules should apply across a specialty.
6.9.6 Booking rules will be routinely reviewed at least on an annual basis with Business Unit staff
with consideration given to discussions related to the Local Delivery Plans
6.9.7 In the event of changes to booking rules being required outside the six weeks notice period,
SLMs and Associate Directors should agree and authorise changes prior to submission to the
Directory of Service Team (DoS). Requests for change will be actioned by administrative staff
on the assumption this authority has already been given.
6.9.8 Requests for new clinics to be set up on the relevant PAS systems should be received by the
Directory of ServiceTeam at least 6 weeks before expected start date or the approximate
waiting time for the service.
6.9.9 In line with NHS e- Referral Service , clinic capacity will be reviewed on a continuous basis and
polling ranges will be published as determined by speciality requirements. Service Line
Managers will be notified on a regular basis of any additional capacity requirements.
6.10 Clinic Changes (Cancellation, reformats, reductions,additions)
6.10.1 For all clinicals sessions held within Medway PAS, the cancelled clinic change proforma
available via the intranet must be fully completed by the relevant consultant secretary or
responsible person for the business unit. For all other PAS systems locally agreed processes
must be followed.
6.10.2 A minimum of six weeks notice of planned clinic cancellations, reformats or reductions must
be given by all clinic staff, together with the reason for such cancellation this include on –call
commitment, audit sessions, or planned annual leave of professional leave.
6.10.3 It is the responsibility of the individual business unit to identify on the proforma where
patients are to be rebooked and also to manage any capacity issues resulting from these
changes.
6.10.4 Any potential breaches caused as a result of clinic amendments will be managed within the
individual business unit.
6.10.5 Only in exceptional circumstances should a patient that has been previously cancelled be
cancelled a second time.
Patient Access (Waiting List/Waiting Times) Policy v7 17
6.10.6 Where an appointment is cancelled by the Trust, an apology will be given to the patient by the
appropriate outpatient support staff on behalf of the consultant (letter). Every effort should
be made to ensure that the patient is offered another date as soon as possible.
6.10.7 For cancellations that are initiated by the Trust, patients should be re-booked as close to their
original appointment date as possible. Service Line Managers will receive monthly
performance dashboards showing cancelled /reduced clinic activity .
6.10.8 When clinics or sessions are cancelled or reinstated or additional waiting list initiatives
requested within 5 days prior to the date of the clinic, secretaries should assist the booking
staff, to contact patients advising them of the changes. Clinics should not be re-instated
without the prior agreement of the appropriate nursing support teams.
6.11 Outpatient Waiting List Validation
6.11.1 All patients will be either fully or partially booked manually or directly booked by the NHS e-
Referral Service, which forms part of the validation process.
6.11.2 As a result of ongoing validation and in accordance with agreed protocols patients will be
removed from the outpatient waiting list in accordance with RTT guidance.
6.11.3 The NHS Constitution mandates that patients are seen within maximum waiting times,
processes have been put into place to investigate any patient queries regarding their right of
access within maximum waiting times. It is the responsibility of all Business units to ensure
these investigations are completed within the agreed timescales and using the investigation
proforma. (appendix 6)
6.12 Management of Inpatient and Daycase Waiting Lists
6.12.1 In line with national and local guidance the Trust is committed to offer all patients a ‘booked
admission’ (Appendix 8). All patients will over time, be offered the opportunity to agree a
booked date for their procedure at the time when a healthcare professional has indicated this
procedure is required, usually at the time of the Outpatient appointment. At this point all
patients should be added to the Waiting List with an agreed booked date.
6.12.2 Patients who receive regular checks or treatments as part of a planned programme of care, are
classified as planned admissions and are not reported on the Waiting List Return but are
recorded on the system.
6.12.3 The computerised waiting list system will be used as the primary tool for waiting list
management to ensure consistency and standardisation of reporting.
6.12.4 The intended management data item on the patient administration system is a crucial part of
the Trust’s overall activity planning process. Only patients who have intended management of
day case will be counted as day cases. Therefore it is very important that there is a reasonable
expectation of no overnight stay the patient is registered as a day case. Patients will be listed
as intended day cases in relation to their procedure.
6.13 Treatment Management
6.13.1 Patients will be registered on Waiting Lists in accordance with National Data Definitions
(Appendix 1).
Patient Access (Waiting List/Waiting Times) Policy v7 18
6.13.2 Clinical priority must be the main determinant of when patients are to be admitted as
daycases or inpatients.
6.13.3 Details of listed patients must be entered onto the computer system within 1 week of the
decision to admit being made.
6.13.4 Each entry must be categorised into clinical priority (urgent, routine or planned) which should
reflect the patient’s need for surgery. Each speciality should have a documented definition for
urgent and routine.
6.13.5 The appropriate departmental staff will add patients to the waiting list on behalf of the
consultant and refer to the PAS training manual prepared by the Information Dept.
6.13.6 Medical staff must make clear to the patient the proposed treatment.
6.13.7 Patients requiring prioir commissioner approval:
As part of NewcastleGateshead CCG value based clinical commissioning an Individual Funding
Request (IFR) policy is in place/development for low clinical value interventions. A list of
specific procedures exists for which IFR is applicable. This is not a fixed list and will be
amended over time as per NICE recommendations and agreed local policy.
Clock stops can only be made to a patients RTT pathway when treatment occurs or a decision
to not treat has been made. No adjustments or clock stops can be made to a pathway whilst a
panel or approval board assesses commissioner approval requests. Patients who require
treatment which must have commissioner approval to commencement must not be
disadvantaged by having their referral returned to primary care. Therefore the referrer to the
Trust must seek prior approval before referring the patient. The approval must accompany the
referral.
In some instances it will not be apparent until the outpatient consultation or on completeion
of diagnostic testing, that the patient requires an excluded procedure. Commissioners should
hold approval panels in line with the 18 week timeframes for any patient referred for
assessment who has already commenced an RTT pathway.
6.13.8 Patients should only be confirmed on the waiting list if:
• There is sound clinical indication for an operative intervention requiring a hospital bed as
either an inpatient or day case, and
• The patient is clinically and socially ready for admission on the day the decision to admit is
made, or
• Should patients contact the trust to communicate periods of unavailability for social reasons
(e.g. holidays, exams), this period should be recorded on PAS.
If the length of the period of unavailability is equal to or greater than a clinically unsafe period
of delay (as indicated in advance by consultants for each specialty), the patient’s pathway will
be reviewed by their consultant. Upon clinical review, the patient’s consultant will indicate one
of the following:
o Clinically safe for the patient to delay - continue progression of pathway. The RTT
clock continues.
Patient Access (Waiting List/Waiting Times) Policy v7 19
o Clinically unsafe length of delay – clinician to contact the patient with a view to
persuading the patient not to delay. The RTT clock continues. In exceptional
circumstances if a patient decides to delay their treatment it may be appropriate to
place the patient under active monitoring (clock stop) if the clinician believes the
delay will have a consequential impact on the patient’s treatment plan or
o Clinically unsafe length of delay – in the patient’s best clinical interests to return
the patient to their GP. The RTT clock stops on the day this is communicated to the
patient and their GP. The patient could also be actively monitored within the trust.
• The patient will agree any provisional date within 24 hours
6.13.9 When the decision is made that a patient requires an inpatient surgical procedure or a day
case procedure, a pre-assessment date should be organised/agreed with them. This pre-
assessment assessment should be within 10 working days of the OP Consultation when the
decision for a procedure is made. At this pre-assessment appointment the following should be
discussed/agreed with the patient and documented:
• Are available to come in at short notice (less than 48 hours) if an unexpected vacancy arises
• Have any special circumstances requiring longer notice than usual for admission (eg, caring for
elderly relative, childcare etc)
• Have any dates when they will not be available for admission, eg, booked holiday, exams etc,
and
• A date will be confirmed with the patient for their surgery
• A TCI date confirmation letter will be sent out by the relevant secretary and will include a
patient information leaflet for that procedure
6.13.10 Patient information leaflets relating to general information about their hospital stay and any
specific information relating to their impending procedure, should be given to the patient at
pre-assessment.
6.13.11 Patients must be placed on the waiting list in chronological order.
6.13.12 Where more than one procedure will be performed at one time by the same surgeon, add first
procedure to the waiting list with additional procedures noted.
6.13.13 Where different surgeons working together will perform more than one procedure at one
time, add patient to the waiting list of the Consultant Surgeon for the priority procedure with
additional procedures noted.
6.13.14 Where patient listed for bilateral procedures, or more than one procedure, but will have initial
surgery on one side at the first admission and subsequent admission for the second side or
procedure:
• Add to the waiting list for the first side/procedure with additional procedures noted
• Put on a planned list for the second side/procedure
• Agree with patient a TCI date for the second side at pre-operative assessment
• Patient will be removed from the waiting list following each procedure
The Peter Smith Surgery Centre
PRE-OPERATIVE ASSESSMENT PROCESS
Patient Access (Waiting List/Waiting Times) Policy v7 20
6.14 Cancellation and Suspension Rules
6.14.1 Patients who self defer for a valid reason should be informed of the likely arrangements for
their future admission. Wherever possible, they should be given a rearranged date at the time
of deferral.
6.14.2 Having been removed from the waiting list following clinical review, if a GP requests that a
patient is placed back onto the waiting list, a new date on the waiting list will be given. Every
effort should be made to ensure that the patient is offered another date according to clinical
priority. Each Business Unit must make local provision to identify how long a patient can wait
depending on specialty and condition.
6.14.3 Theatre lists should not be cancelled within six weeks except through illness or other
unforeseen circumstances. If cancellation is unavoidable notification should be made
according to the procedures described in the Trust Operating Theatre Performance (Scheduled
Sessions) Policy – OP38. Failure to comply will result in an investigation led by the Business
Unit Associate Director or their nominated deputy
Patient Access (Waiting List/Waiting Times) Policy v7 21
http://www.gatesheadhealth.nhs.uk/freedom-of-information/policies-and-
procedures/documents/Live/OP38%20Operating%20Theatre%20Performance%20Dec%20200
8.pdf
6.14.4 Where an operation is postponed by the Trust a verbal explanation together with an apology
will be given to the patient by the appropriate Business Unit support staff on behalf of the
Consultant. The aim must be to offer a new admission date at the time of cancellation
wherever possible. Every effort should be made to ensure that the patient is offered another
date as soon as possible within a maximum wait of a further 28 days.
6.14.6 If an operation is cancelled, for non-clinical reasons on the day of admission, after admission or
on the day of the operation, the patient should be offered an admission date within 28 days of
the cancellation. This should be noted on the waiting list record to ensure that this patient is
not cancelled again. Operations cancelled on the scheduled day for non-medical reasons, form
part of the national reporting standard of Trust’s Performance Indicators.
6.14.7 If patients are cancelled for medical reasons arrangements should be made for the patient to
receive remedial treatment and a review arranged for the patient to attend pre-operative
assessment or the consultant depending on clinical need. The patient’s RTT clock will continue
to tick until a clinical decision is made to not treat. If a decisison is made to not treat, then the
clock will stop and the patient will be referred back to the care of their GP (and/or initial
referrer). Where there is a decision made not to treat, but to retain clinical responsibility for
the patient (for regular outpatient follow-ups etc) then it may be appropriate to start a period
of active monitoring which will also stop the patient’s clock.
6.15 NHS Constitution / Patient Choice
6.15.1 Patients who may potentially wait longer than 18 weeks may be eligible for choice at the
discretion of their commissioning CCG (Appendix 6).
6.15.2 The CCG will be notified of waiting times for each specialty and will identify whether any
patients waiting in excess of 18 weeks should be offered choice at a different provider
organisation.
6.15.3 If choice is not to be offered the patient will maintain their existing place on the waiting list
and continue through the care process. They would then be reported as a breach.
6.15.4 If choice is to be offered the CCG commissioner will be required to identify an alternative
provider (receiving hospital) and inform the Trust of this arrangement.
6.15.5 Any alternative offers made should be for faster treatment than would be possible
in Gateshead Health NHS Foundation Trust (the originating hospital).
6.15.6 For those patients who accept the offer of choice the Trust (as originating hospital) will
provide all appropriate patient details to the receiving hospital, including access to clinical
records in a timely way in order that the receiving hospital can progress treatment.
6.15.7 If a patient chooses an alternative provider and has been clinically accepted by that
provider after a pre-assessment consultation, then the patient is removed from
the originating hospital's waiting list and is entered onto the receiving hospital's waiting list.
6.15.8 Patients are not obliged to accept the offer of an alternative hospital and cannot be
suspended for not accepting such an offer. If the patient does not agree to transfer they
Patient Access (Waiting List/Waiting Times) Policy v7 22
will be made a reasonable offer with their responsible consultant within their original
guarantee date.
7 Training
7.1 To ensure high quality waiting list administration and continual maintenance of data
quality, all staff involved in waiting list management will be trained by the Information
Department to a standard level, tailored to the individual’s responsibilities as part of an
ongoing programme.
7.2 The programme will recognise differences in local administration arrangements while
ensuring consistency in the implementation of this policy. Both new starter and refresher
programmes will be provided on a regular basis. Associate Directors are responsible for
ensuring their staff are fully trained and receive appropriate refresher training
8 Diversity and Inclusion
The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide
services to the public and the way we treat staff reflects their individual needs and does not
unlawfully discriminate against individuals or groups on the grounds of any protected characteristic
(Equality Act 2010). This policy aims to uphold the right of all staff to be treated fairly and
consistently and adopts a human rights approach. This policy has been appropriately assessed.
9 Process(s) for monitoring compliance with the policy
This effectivenss of this policy will be monitored by the indicators below
Standard / process
/ issue
Monitoring and audit
Method By Committee Frequency
End to End
outpatient booking
processes audit
Referrals,
Medway,EMIS, RIS
Booking team
and Reception
teams
Data Quality
Group
Monthly
Cancelled clinic
activity
Cancelled clinic
reports provided by
Information team
Service Line
Managers
Monthly
Cancelled inpatients
activity
Achieving the
Targets
Performance
reports
Service Line
Managers
Waiting List
managers
Weekly
Outpatients waiting
reports
QM08/RTT PTL
provided by
Information team
Waiting List
Managers
Weekly
RTT Standards RTT performance Performance
Team /
Information
Finance &
Performance
Committee
Monthly
Long waiters Performance
monitoring of 40+
week waiters
Performance /
service line
managers
Finance &
Performance
Committee
Weekly
Patient Access (Waiting List/Waiting Times) Policy v7 23
10 Consultation and review
10.1.1 This policy has been reviewed in consultation with the finance and performance committee
on behalf of Trust Board, Clincal Policy Group, and the CCG
11 Policy implementation (including awareness raising)
11.1.1 This policy will be circulated by the Trust Secretary as detailed in OP 27 policy for the
development and authorisation of policies.
11.1.2 The policy will be shared at the DataQuality Strategy Group.
12 References
OP11a Private Patient Policy
OP12 Treatment of Overseas Visitors Policy
OP18 Copy letters correspondence
OP38 Operating Theatre Performance (Scheduled Sessions) Policy – OP38
OP90 Cancer Operational Policy
Patient Access (Waiting List/Waiting Times) Policy v7 24
Appendix 1
Definitions
Inpatients/Daycases
RTT Refers to Consultant-led Referral To Treatment (RTT) waiting times,
which monitor the length of time from referral through to elective
treatment. For further information on RTT waiting times please visit
the below link:
https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-
waiting-times/rtt-guidance/
Active Waiting List Patients awaiting elective admission for treatment who are currently
available i.e. fit, able and ready, to be called for admission
Fully Booked Patients
Booked admissions Patients awaiting elective admission who have been given an
admission date which was arranged by offering the patient choice and
agreed with the patient at the time, or within one working day of the
decision to admit. These patients form part of the active waiting list
Inpatients Patients who require admission to hospital for treatment and are
intended to remain in hospital for at least one night
Day cases Patients who attend hospital for an interventional procedure and are
discharged home within the same day
Decision to Admit (DTA) The date on which a Healthcare Professional confirms that a patient is
fit to be admitted for an procedure. This date should be recorded on
the hospital PAS system. The DTA date is the effective date when the
patient waiting time commences. It is therefore imperative that this
date is accurate and is recorded as the actual date the decision was
made, not the date the patient was added to the list
Waiting List Admission A patient admitted electively from a waiting list not having been given
a date for admission when the decision to admit was made
TCI The date on which patient is due To Come Into hospital for treatment
as daycase or inpatient
SOP Standard operational procedure
EROD Earliest reasonable offer date
Appendix 1 (cont)
Patient Access (Waiting List/Waiting Times) Policy v7 25
Outpatients
Outpatients Patients referred by a General Practitioner, another Healthcare
professional or self referral, for clinical advice or treatment
Partially Booked Patients Where a service operates a partial booking system, the patient will be
added to the partial booking worklist in the appropriate timescales as
instructed by the clinic outcome slip. A letter is sent to the patient at
an agreed timescale (service specific) in advance of the expected due
date of appointment, asking the patient to telephone the hospital. An
appointment is agreed with the patient upon contacting the hospital.
A confirmation letter is sent to the patient. If the patient does not
contact the hospital a reminder letter is sent. If the patient fails to
contact the hospital the patient is removed from the partial booking
worklist and the referring clinician informed.
NHS e-Referral Service Is a national system that allows referrers and patients to search for the
provider of choice and enables and electronic booking of date and time
of first consultant outpatient clinic.
Directly Bookable The patient will be able to NHS e-Referral Service to book an an
appointment with their chosen provider following a referral via their
GP. These appointments can be made directly in the GP practice, via
the National Appointments Line (TAL) or by the patient via NHS
Choices website.
Date of Receipt of Referral The date on which a hospital received a referral letter from a GP or
other referrer (DRR). The waiting time for outpatients is calculated
from this date. The waiting time for NHS e-Referral Service patients is
calculated from the date of the Unique Booking Reference Number
(UBRN) conversion date i.e., the date on which the patient actually
booked their appointment. In the event of capacity issues within NHS
e-Referral Service the GP will add the patient to the Defer to Provider
worklist . The DDR is calculated from the date the patient appears on
this worklist. NB. For onward referrals from MSK Cats services via NHS
e-Referral Service where 1st definitive treatment has not been given
the pathway start date (date the original referral was received into the
MSK Cats service) must also be recorded
List (Pending) on hold lists A holding list of patients waiting for an outpatient appointment. The
process ensures patients are seen in chronological order and have the
opportunity to choose a convenient date
Directory of Services (DoS) The Directory of Service (DoS) is the core of the NHS e-Referral
application. It holds information that describes the types of services
the Trust offers, including service specific referral criteria and guidance
which enables the referring clinician to search for appropriate services
to refer patients. The DoS also provides patients with a list of suitable
providers for their treatment.
Appendix 1 (cont.)
Patient Access (Waiting List/Waiting Times) Policy v7 26
SNOMED Is the common language which will eventually be used by all
Systematised Nonmeclature computers across the NHS. These terms
are loaded each Directory of Service published in NHS e-Referrals to
enable referrers to search for the appropriate service without the need
to use clinic types or specialities
Appointment Slot Issue (ASI) Is the term given when inadequate capacity is available for direct
booking via the NHS e-Referral service.
UBRN Unique booking referernce number is allocated to a referral by the
NHS e-Referral Service at the time the GP raises a referral in the
system.
PAS Trust patient administration systems (Medway/ EMIS/ Carestream RIS/
Endosoft etc)
SOS See on request, given to patients who do not require specific follow up
but have the opporturnity to arrange an appointment if the need arises
within a specific time frame from their last appointment
Inpatients, Day Cases & Outpatients
Planned Admissions Patients who are to be admitted as part of a planned sequence of
treatment or investigation. The patient has been given a date, or
approximate date at the time a decision to admit was made. These
patients are not counted as part of the active waiting list
Did Not Attend (DNA) Patients who have been informed of their date of admission or pre-
assessment (inpatients/day cases) or appointment date (outpatients)
and who without notifying the hospital did not attend for the
admission/ outpatient appointment
Cancellation When a patient cancels an appointment (Cancelled by Patient – CBP)
or the Hospital cancels an appointment (Cancelled by Hospital – CBH)
Self-deferrals Patients who, on receipt of reasonable offer(s) of admission, notify the
hospital that they are unable to come in
Duty of Care The duty of care rests with the referrer until such time as the referral is
accepted by the provider or a Clinical Assessment Service
Tertiary Referrals Tertiary Referrals are those referrals between Healthcare professionals
from outside of the Trust
Cons to Cons referrals Are referrals between healthcare profession within the Trust.
Patient Access (Waiting List/Waiting Times) Policy v7 27
Appendix 1 (cont.)
Inter-Provider Transfer A form used to accompany patients’ transferred to Gatehead Health
NHS Foundation Trust from another provider showing RTT status
Minimum Data Set Form Used when patients are referred internally between clinicians
identifying continuation of pathway or new condition
Private Patients Private patients who have made separate arrangements to be treated
by a practitioner may be charged professional fees by the Consultant /
Health Care Professional (OP11a Private Patient Policy)
http://www.gatesheadhealth.nhs.uk/freedom-of-information/policies-
and-procedures/documents/Live/OP11%20Private%20Patients.pdf
Overseas visitors Persons, who are not normally resident in the UK, may be called upon
to pay the cost of their hospital treatment unless they meet one of the
exemptions from charges (OP11b Treatment of Overseas visitors &
Asylum seekers policy)
http://pandora/docs/policies/DOCUMENTS%20POLICIES/Forms/Opera
tional.aspx
Breach date A pathway will become a breach on the day after the breach date if the
patient has not received the appropriate appointment/diagnostic test
or treatment
PTL Patient tracking list
CCG Clinical Commission Group
Patient Access (Waiting List/Waiting Times) Policy v7 28
Appendix 2
National Waiting Times Guidelines – DSCN 07/2003
Patient Access (Waiting List/Waiting Times) Policy v7 29
Appendix 2 (cont.d..)
National Waiting Times Guidelines – DSCN 07/2003 (Page 2)
Patient Access (Waiting List/Waiting Times) Policy v7 30
Appendix 2 (cont.d..)
National Waiting Times Guidelines – DSCN 07/2003 (Page 3)
Patient Access (Waiting List/Waiting Times) Policy v7 31
Appendix 2 (cont.d…)
National Waiting Times Guidelines – DSCN 07/2003 (Page 4)
Patient Access (Waiting List/Waiting Times) Policy v7 32
Appendix 3
Consultant to Consultant Referral – Out Patient Guideline
1. Introduction
Patients want high quality care. With greater specialisation there is a growing need for primary and
secondary/tertiary care to work effectively together to ensure that this is delivered. The General
Practitioner has a pivotal role as a navigator for individual patients care.
Newcastle Gateshead CCG would like to ensure that Consultant to Consultant referrals are minimised to
the specific areas detailed in this guidance. General Practitioners are Expert Generalists and referrals for
conditions not related to the original problem should be directed back to them.
C2C referral activity will be monitored in line with the contract agreement and will only be funded in line
with the agreements in the contract.
2. Revised C2CR Protocol
2.1 Internal C2C Referrals
Whilst it is recognised that C2CR make up the majority of internal referrals this protocol also applies to
referrals from, and between, other healthcare professionals.
To allow choice and treatment to be provided by the best placed clinician, secondary care clinicians should
not refer directly to internal colleagues except in specific circumstances described below. Instead they
should write to the GP and/or originating referrer to advise on appropriate treatment and further
management. Many conditions can be managed by the skills available in primary care and do not require
secondary care input until these have been completed. Letters back to primary care may be used as the
onward referral letter if they agree that an onward referral is needed so secondary care teams are asked to
include any detail a future specialist may need.
2.2 Internal C2CR referrals will only be allowed in exceptional cases, as follows:
i. Where the referral is clinically urgent (2 week wait), for example:
• Suspected cancer.
• Where any short delay might be life threatening
ii Related to the original issue for which the patient was referred
The C2C referral arises from a pre-assessment clinic visit and the referral is required to facilitate the
procedure for which the patient was referred.
iii Referrals from A&E where failure to make an OPD referral will result in clinical deterioration leading to
either admission or re attendance at A&E in the short term i.e. next 7 days. NB: Where relevant
Primary/Community based services exist these should be considered as the first destination to manage
the patient’s condition e.g. community based musculo-skeletal clinics or COPD service.
iv Where after appropriate assessment and investigation, the problem turns out to be due to a condition,
the management of which is outside the area of expertise of the initial consultant, then it would be in
the patient’s best interest and expeditious for a referral to another consultant.
V Where it is in the patient’s interest to be referred to one or more other consultants within the MDT e.g.
patients suffering from chronic complex conditions may need involvement from a range of clinicians
Patient Access (Waiting List/Waiting Times) Policy v7 33
who form a Multi-Disciplinary Team. However ongoing follow up by multiple consultants should, so far
as practicable, be minimized.
vi Referrals to “Hot Clinics” such as first fit clinic and fracture clinic from A&E (and to orthopaedics from
the fracture clinic).
• Acute Providers retain discretion to deliver any referral falling within the following 3 categories within a
timeframe relevant to maintain clinical momentum in the patient pathway
vii Where sub-acute true “tertiary” referral is needed relating to the condition or symptoms that triggered
the original referral.
viii Where referrals form part of local priorities including Quality Indicators such a
CQUIN.
viiii Where it is necessary, as part of the investigation of the presenting problem, to perform specialist
investigations (e.g. endoscopy) then a referral to a consultant with the necessary skills should be made
ix The C2C referral arises from a pre-assessment clinic visit and the referral is required to facilitate the
procedure for which the patient was referred.
All other recommendations that Consultants might wish to make for onward referral must be forwarded to
the patients GP and/or originating referrer for their review. C
Commissioners, GPs and secondary care providers, want to ensure that patients are seen by the most
appropriate clinician to deal with their problem whilst also ensuring that it minimises:
• Clinical risk
• Delays in clinically urgent cases;
• Patient inconvenience;
Patients with suspected cancer or other urgent problems must not have their care or diagnosis delayed.
Shifting the responsibility and accountability for Consultant referral from acute Trusts back to the GP,
except in the circumstances outlined above, will ensure that the long term management of a patient
remains within the oversight of the registered practice and decisions on patient care will be made jointly
between patient and GP and where appropriate involve secondary and tertiary care clinicians.
2.3 No other internal C2C referrals will be funded by the CCG and patients must be referred back to the
GP and/or originating referrer where the intended C2CR referral is:
i. For a clinical condition that is not directly related to the reason for the original referral or is an
incidental clinical finding. E.g. a dermatological condition in a patient referred for a surgical reason.
If investigations of the presenting problem turn up some incidental abnormal finding or condition that
would normally be managed in primary care (e.g. an elevated blood sugar in a patient who is well and who
has no symptoms of diabetes) the abnormal result should be communicated to the GP. Onward referral
should not be made. It is important that the practice is contacted urgently with a clear reason why tests
were done and which issues the practice is expected to address.
ii. Made following an attendance at A&E for a condition that is not clinically urgent
iii. Referrals to Adult pain clinics can only be made by primary care. Patients with ongoing pain issues
should be referred back to the GP for further planning of care to ensure all the initial parts of the
pain pathway have been completed before referral is made.
Patient Access (Waiting List/Waiting Times) Policy v7 34
iv. The referral does not fall into any of the exceptional categories above.
2.4 Original referral sent to the wrong clinical team
Where the original referral was to the wrong clinical team - these referrals should be referred onwards to
the appropriate internal Speciality clinical team. This is consistent with the Choose and Book policy on
redirected referrals. Commissioners will work with providers and referrers to ensure that the DOS is up to
date, that triage takes place by providers and that referrers ensure referrals are directed to the correct
clinic.
2.5 Patients admitted as an emergency with a problem already under review
If a patient is admitted as an emergency with a problem that is already being reviewed in OPD and a clinical
follow up is required, then the on call consultant for that admission should if necessary refer the patient
back to the “usual” consultant as a “REVIEW at OPD” if the patient has been seen within the last 6 months
2.6 Referring back to the GP
When referring the patient back to the GP for follow up related to any of the above non-urgent reasons the
responsibility for the patient’s on-going clinical care passes back to the GP. The patient must be informed
that they will need to contact their GP. The Consultant/Health Professional will write back to the GP –
ensuring the letter is received within 10 days in 2017/18 as per contract and 7 days in 18/9- outlining
clinical assessment and management so far and provide advice on potential treatment options and/or
reasons why onward referral to an appropriate speciality is considered necessary. Communication with the
patient will be key. Patients should be informed that they are being referred back to their General
Practitioner for discussion on further management of the problem, rather than that their GP will arrange a
referral. Letters to GP’s must clearly state recommendations for the GP and that the patient has been
requested to make contact to discuss the issue of concern.
3. Guiding Principles: Consultant to consultant referrals
3.1 Commissioner quality expectations
• Patient care is not compromised
• Patients continue to receive timely care.
• Changes do not hinder the 18 week target
• That the changes are cost effective.
• Changes do not encourage perverse clinical practice to circumvent C2CR policy
• That Junior medial staff are made aware of the policy and these principles. It is recommended
that they would form part of their induction.
• Triage of referrals is performed to ensure that patients are seen by the appropriate clinical team
3.2 Referral criteria outcomes
• Consultant to consultant referrals across specialties no longer take place for non-urgent and non-
related conditions.
Patient Access (Waiting List/Waiting Times) Policy v7 35
3.3 Relevant referral standards to be met where they exist C2CR Protocol
• Consultant to consultant referrals in line with best practice for example NICE / Map of Medicine /
Network pathways
3.4 Audit processes used to track changes
• Formal audit will be carried out as part of the contract monitoring processes
We are keen to avoid unintended consequences of this policy. If you have suggestions to improve
this please contact me:
Dr Steve Kirk, Clinical Director, Newcastle
Patient Access (Waiting List/Waiting Times) Policy v7 36
Appendix 4
Priority Treatment for War Pensioners and Military Veterans
Health Service Guidelines
HSG(97)31
Date: 18 June 1997
PRIORITY TREATMENT FOR WAR PENSlONERS
Executive Summary
These guidelines advise health authorities and trusts of an extension of the definition of the term “war
pensioner” to cover people who were injured or disabled as a result of service in the armed forces either
before the First World War or between 1 October 1921 and 2 September 1939, the “inter-war years”.
Health authorities and trusts are also reminded of the arrangements for priority treatment of war
pensioners.
Action
Chief Executives of health authorities and trusts should ensure that general practitioners and relevant
hospital staff are advised of the new definition and are reminded of the arrangements for the priority
treatment of war pensioners.
Background
A war pensioner has previously been classified as someone who has a pension or who had a gratuity for
disablement caused by armed service during the 1914-18 and 1939-45 wars and service since 1945. This
includes merchant seamen and civilians who receive pensions for wartime injuries.
The term “war pensioner” has now been extended to cover people who were injured or disabled as a result
of service in the armed forces either before the First World War or between 1 October 1921 and 2
September 1939, the “inter-war years”.
In 1953 hospitals run by the Ministry of Pensions for the treatment of war pensioners were transferred to
the NHS. The Government gave an undertaking that there would be priority examination and treatment for
war pensioners in NHS hospitals for the condition or conditions for which the war pensioners received a
pension or gratuity.
NHS hospitals should give priority to war pensioners, both as out-patients and in-patients, for examination
or treatment which relates to the condition or conditions for which they receive a pension or received a
gratuity (unless there is an emergency case or another case demands clinical priority). Priority should not
be given for unrelated conditions.
Referrals for treatment should make it clear that the patient is a war pensioner and requires treatment for
the condition or conditions for which the war pensioner was given a pension or gratuity.
War pensioners can use the NHS complaints system to resolve any alleged breakdowns in the
arrangements for priority treatment. This includes ultimately asking the Health Service Commissioner to
investigate their case
Cancelled Circular
HSG(94)28 is cancelled
Appendix 4 (Cont.d…)
Patient Access (Waiting List/Waiting Times) Policy v7 37
Addressees
For action:
Chief Executives of Health Authorities
Chief Executives of NHS Trusts
For information:
Regional Directors
From
NHS Executive
Health Services Directorate
Wellington House
135-155 Waterloo Road
London SEA U
Tel: 0171-9724833
Further copies of this document are available from:
Department of Health
PO Box 410
Wetherby
LS23 7LL
Fax 01937 845 381
or by calling the NHS Responseline on 0541 555 455
© Crown copyright 1997
10901 HCD 1300 1P JUN97 SA (0)
Patient Access (Waiting List/Waiting Times) Policy v7 38
Appendix 4 (Cont.d…)
From the Chief Medical Officer, Sir Liam Donaldson
9th
February 2010 Richmond House
79 Whitehall
To: GPs London
SW1A 2NS
Copies: Chief Executives SHAs, CCGs, NHS acute
and mental health trusts and NHS Foundation trusts Tel: +44 (0)20 7210 5150-4
Fax: +44 (0)20 7210 5407
www.dh.gov.uk/cmo
Gateway Reference 13406
Dear Colleague
ACCESS TO HEALTH SERVICES FOR MILITARY VETERANS – PRIORITY TREATMENT
The purpose of this letter is to advise you of the guidance in place to ensure that military veterans receive
priority access to NHS secondary care for any conditions which are likely to be related to their service,
subject to the clinical needs of all patients.
Action
GPs are asked, when making referrals relating to a military veteran for diagnosis or treatment, where they
are aware of the patient's veteran status, to record that status as part of the referral. If the patient does
not want the GP to record their veteran status the information should not be included. If GPs consider that
priority treatment might be appropriate because the condition to which the referral relates is likely to be
related to the patient's time in the services, GPs are asked to include details in the referral.
Background
The ongoing deployment of UK armed forces means it is now more important than ever that the NHS works
closely with military services to ensure that the health needs of the Armed Forces, their families and
veterans are appropriately met. In particular, it will be important to provide priority treatment, including
appropriate mental health treatment, for veterans with conditions related to their service, subject to the
clinical needs of others.
There are about 5 million veterans in England (a veteran is defined as someone who has served at least one
day in the UK Armed Forces). For the vast majority of veterans their time in the service will have been a
positive experience but some will leave with medical conditions resulting from their time in service.
Patient Access (Waiting List/Waiting Times) Policy v7 39
Appendix 4 (Cont.d…)
In December 2007, the Chief Executive of the NHS wrote to Chief Executives of Strategic Health Authorities,
Primary Care Trusts, NHS Foundation Trusts and NHS acute and mental health trusts (Gateway reference
9222) informing them that the extension of priority treatment arrangements for veterans would commence
from 1st
January 2008, and asked that GPs and others were made aware of this.
Successive NHS Operating Frameworks, including that published in December 2009, have continued to
reiterate the requirement for CCGs to ensure the needs of this community are appropriately met. Despite
this, research by the Royal British Legion has shown that few GPs are acting on these provisions. Given the
ongoing nature of UK Armed Forces involvement in Afghanistan and the current and future needs of the
veteran population, it is important that access to priority treatment is identified where appropriate.
Next Steps
Where the patient is content for their veteran status to be included, GPs are asked to clearly state this
when drafting referral letters including, in your clinical opinion, that the condition may be related to
military service.
When utilising Choose and Book, GPs are asked to refer normally and select the correct appointment
priority based upon the patients medical condition (routine / urgent or 2 week wait) including veteran
details in the referral letter (refer: http://www.chooseandbook.nhs.uk/staff/communications/fact/Armed-
Forces.pdf)
Where secondary care clinicians agree that a veteran’s condition is likely to be service-related, they are
asked to prioritise veterans over other patients with the same level of clinical need. However, and as set
out in David Nicholson’s letter of December 2007, it remains the case that veterans should not be given
priority over other patients with more urgent clinical needs.
In order to ensure continuity of care, it is anticipated Defence Medical Services will commence direct
transfer of medical records to GPs when individuals leave the Armed Forces. GPs and practice nurses are
asked to include as a minimum the “History Relating to Military Service” code (Read: Code Xa8Da or
SNoMed CT: 302121005) against all known veterans within the practice.
If you have any queries about this letter, please contact: Department of
Yours sincerely
Sir Liam Donaldson KB
Chief Medical Officer
Patient Access (Waiting List/Waiting Times) Policy v7 40
Appendix 5
DNA process
This process is not intended to remove clinical decision making
Patient Access (Waiting List/Waiting Times) Policy v7 41
Appendix 6
NHS Constitution - Initial Contact Information
Date: Time:
Patient
Details
Full Name: dob:
Address:
Unit Number: NHS Number:
Callers Details Name:
(if not the patient): Relationship to patient:
Speciality: Consultant:
18 week target 2 week target
Preferred Contact Home:
Details: Mobile:
Work:
e-mail:
Preferred time for call
Reason for Call:
Action Taken:
By Whom – Name / Title:
Date: Time:
FORWARD TO BOTH SPECIALITY WAITING LIST MANAGER AND DISTRIBUTION LIST
WITHIN ONE HOUR OF RECEIPT
Patient Access (Waiting List/Waiting Times) Policy v7 42
Appendix 6 (cont.d…)
TO BE COMPLETED WITHIN 24 HOURS OF RECEIPT OF ISSUE
NHS Constitution - Speciality Investigation
Patient Time Line (to include target breach date):
YES NO
Has the patient met the specified targets?
YES NO
Can a sooner appointment be made?
Discussion with Patient:
Date: Time:
YES NO
Outcome:
Does patient require alternative provider?
YES NO
Is the patient willing to travel?
Action Taken Following Discussion with Patient:
Instructions to CCG (to include type of appointment required, eg: OPD, test, surgery)
Form completed by
(name)
Title:
Date: Time:
E-MAIL PROFORMA ONTO DISTRIBUTION LIST
FORWARD ON DETAILS TO CCG
Patient Access (Waiting List/Waiting Times) Policy v7 43
Appendix 6 (cont.d..)
NHS Constitution - CCG Communication Form
YES NO
Is an alternative provider being requested?
Details of Alternative Provider Sort:
Final Outcome:
Form completed by
(name)
Title:
Date: Time:
E-MAIL PROFORMA BACK TO BOTH SENDER AND DISTRIBUTION LIST
Patient Access (Waiting List/Waiting Times) Policy v7 44
Patient Access (Waiting List/Waiting Times) Policy v7 45
Appendix 7
Patient Transport Service Eligibility Criteria - Frequently Asked Questions
From the 20th
October 2014 all new planned Patient Transport Service (PTS) bookings became subject to an
eligibility assessment; this currently excludes bookings made in Sunderland and North Tyneside. This takes
the form of a small number of questions being asked at the time of booking. The aim of this is to help
ensure that only those patients who genuinely need patient transport receive it.
The aim of this leaflet is to answer some of the questions that we have been asked since the criteria was
implemented. We aim to circulate regular updates as the assessment process is refined and embedded.
I have had problems contacting my booking provider – is there a risk of a delay if I am trying to book an
Urgent Ambulance?
No, urgent ambulances are booked through a separate telephone number and a different staff group.
Please make sure that you are ringing the correct number for the service you require. Please do not use the
urgent line to attempt to either book transport or notify NEAS that a patient is ready for collection as you
will be directed back to the main booking number.
Questions for Hospital Staff
Are hospital discharges affected?
If a patient is being discharged from an inpatient stay then they will not be subject to the eligibility
assessment. If the patient is being treated as an outpatient or a day case and already had a return journey
booked then you will not need to go through the criteria again. If you are booking follow up outpatient
appointments, these will be subject to assessment. If the patient already had transport booked but this had
to be cancelled and a new booking is being made, the booking will be subject to assessment.
Are inter-hospital transfers for specialist appointments subject to an eligibility assessment?
No, all inter-hospital transfers will not be subject to an eligibility assessment.
Do the criteria affect ‘Ringing Ready’? (Informing NEAS that a patient has completed their appointment
or treatment and is ready for collection)
No, as the patient has already been assessed as eligible for the journey at the time it was originally booked.
However, the contact centre is currently experiencing a high volume of calls; therefore ring ready calls may
take some time to get through and NEAS is strongly recommending that the online system be used where
possible to notify when a patient is ready for collection.
If your department does not have access to the online booking or if you are having any difficulties using the
system please contact the NEAS Customer Care Team on:
Tees/South Durham areas - 07969 193544
North Durham/South Tyne - 07817 812511
North Tyne/Northumberland - 07973 970994
Alternatively, email: [email protected]
If a patient is unhappy with the outcome of the assessment what do I do?
If a patient has been determined as ineligible by the assessment but either the patient disagrees with this
or wishes to make a complaint, you can refer them to the Patient Advice and Liaison Service (PALS). Further
information on this can be found in the PTS Appeals Process Leaflet that accompanies this FAQ document.
Appendix 7 (cont.d..)
Patient Access (Waiting List/Waiting Times) Policy v7 46
Has the criteria gone live across the whole region?
No, the criteria will be live across the region by the end of 2014. Sunderland and North Tyneside have not
yet implemented the eligibility assessment. The planned dates for implementation in these areas are as
follows:
Sunderland: 3rd
November 2014
North Tyneside: 1st
December 2014
Final confirmation of these dates will be made as each date approaches.
Are any patients or medical treatments/conditions exempt from the criteria?
Yes, for the present time all bookings that are to transport patients to receive oncology or renal dialysis
treatment are exempt from any eligibility assessment. This decision may be reviewed in due course.
Questions for Transport Bookers
If I book a return journey will the assessment take place twice?
Maybe, if a patient is assessed as being eligible for transport to an appointment, then they will
automatically be eligible for the return journey. However, if a patient is not eligible for transport to an
appointment, they may still qualify for transport back depending upon the treatment received. An example
would be a patient who can use public transport but is attending for an ophthalmic procedure and will not
be able to make their own way home independently. This patient would be expected to make their own
way to the appointment but would qualify for transport back, if there were friends or family able to assist
them.
If I make multiple bookings at one time for the same patient, do I have to go through the criteria for each
booking?
Currently yes, however we are looking to develop the system to avoid this.
If I am amending an existing regular booking will it become subject to an eligibility assessment?
Any changes to a booking that require a new booking to be created on the system will automatically be
subject to the eligibility assessment. This applies whether the regular booking was set up prior to or after
the implementation date.
I am trying to use the online booking portal to make an out of area booking, why can I not do this?
Out of area bookings are a more complicated process and require assessment and authorisation from the
CCG. You will need to contact your booking provider by telephone to make this type of booking.
Patient Access (Waiting List/Waiting Times) Policy v7 47
Appendix 8
Trust Procedures for Inpatient and Day Case Waiting Lists
Consultant decides to admit for
surgery/procedure
POA not required
NP advises secretary to
send patient info leaflet
with TCI confirmation
letter
Consultant offers date to
patient using diary/paper
record of next available theatre
slot
Medical questionnaire
completed by patient (includes
any time patient next available
in next 10 working days)
Notes and medical
questionnaire to Pre-operative
Assessment
NP decides if POA required and
decides on most appropriate
slot, i.e. anaesthetic appt etc.,
within 10 working days
POA clerk puts patient onto
PAS and ends confirmation
letter
Patient Access (Waiting List/Waiting Times) Policy v7 48
Eligibility Criteria
Patient Clinical Needs Banding (excludes First Response)
Category Clinical Needs of Patient
A - Life-threatening call
(999 call)
Paramedic / Technician Crew Arrangements made by
contacting Accident &
Emergency Control
B - Serious (999 call) Paramedic / Technician Crew
C - Neither life threatening nor
serious (999 call)
( Paramedic crew )
or
( Technician crew )
or
( Support Tier crew )
D - Urgent Journey (Doctors Urgent
callE - Non-urgent A&E needs A&E
crew but not time critical. (Doctors
urgent call)
F - Short notice, non-emergency
journey for specialist referrals and
admissions ie oncology/plastics/eyes
Double crew – may need oxygen,
2 staff, manual handling /
mobility skills
NB Patients on drips and infusion
pumps must have a nurse escort,
otherwise A&E
Arrangements made by
contacting Patient Transport
Service Control and or
Planning section. Capacity
depends on availability
G - Non-emergency journeys
requiring ��
Double crew – may need oxygen,
2 staff, manual handling /
mobility skills
NB Patients on drips and infusion
pumps must have a nurse escort
H - Non-emergency journey requiring
��
Single crew with manual
handling/mobility skills
I - Non-emergency journey requiring
��
Unskilled single crew or
Ambulance Car Service
Patient Access (Waiting List/Waiting Times) Policy v7 49
Waiting lists should be kept up to date by identified Trust staff. There is a need to ensure that patients are
listed promptly and that the list does not contain patients who no longer need their operations at the
hospital.
Details of listed patients must be entered onto the computer system within one week of the decision to
admit being made. Failure to do this will lead to incorrect assessment of waiting list size when the monthly
census is taken.
a) Adding Patients to the Waiting List
When a patient opts not to accept a reasonable available admission date (21 days notice) or
requests admission not to take place prior to a given date, due to non-medical personal or social
reasons, their case should be reviewed individually. Other than in extenuating circumstances, the
patient should be referred back to the GP, for appropriate care management, or suspended from
the waiting list until they are willing to be admitted. Both patient and GP to be informed in writing
of the action. Exceptions require the authorisation of the appropriate Associate Director.
b) Selection of Patients for Admission
The appropriate directorate staff will create the TCI list (using standard format) in order to provide
written confirmation of elective admission (TCI letter). The TCI letter should contain the following
core details:
Patient’s name
Date letter sent to patient
Date and time of admission
Arrangements for transport
Where to report on arrival
Response required from the patient
Named contact for queries relating to admission
Reference to check bed is available on day of admission
Reasons for checking bed availability
Information about the planned treatment
They should be sent out in the name of the Consultant
If letters are not sent out on the day or preparation from the PAS system, they must be double
checked to ensure that the patient is not already in hospital or has not died in the interim. Letters
should clearly state what action the patient must take in order to confirm or decline their offer of
admission. Request a response either by telephone (to a named individual) or on an enclosed
response slip (with a business reply envelope)
The process of selecting patients for admission and subsequent treatment is a complex activity. It
entails balancing the needs and priorities of the patient and Purchaser against the available
resources of theatre time and staffed beds
Patient Access (Waiting List/Waiting Times) Policy v7 50
War Pensioners should receive priority treatment if the condition is directly attributable to injuries sustained
during the war periods.
Patients who move house:
OPTION
Consideration should be given if any account can be taken of the previous wait at the other hospital. If
possible the earlier decision to admit date will be observed
c) Transfer between Providers
� Transfers to alternative providers must always be with the consent of the patient, their GP and the
transferring Consultant*. If a patient does not wish to be transferred, the original provider must ensure the
patient is admitted for treatment in compliance with the Patient’s Charter
Purchaser offers patient treatment at another hospital
Patient and GP permission sought and obtained
Consultant at second provider accepts patient on Waiting List with the original date on the Waiting List
Patient removed from Waiting List at original provider
If the patient and/or GP declines offer the patient remains on the Waiting List of the original provider
*EL(95)57 The Transfer of Patients to Shorter Waiting Lists applies
Patient moves house
A
Remain on Waiting List of
original hospital
B
Choose to transfer to new hospital
Normal guarantee applies Original guarantee no longer applies
Guarantee applies from date new Consultant put patient on Waiting List
Patient Access (Waiting List/Waiting Times) Policy v7 51
Review and Validation
� Review will be undertaken by the appropriate Divisional support staff on a weekly basis using standard
PAS reports generated and printed locally
� The Associate Director will review their waiting lists at least once a month to ensure that details are
accurate and up to date reporting mechanisms to be agreed
� The Associate Director in liaison with the Information Department will validate each waiting list at least
twice per year by sending waiting list review letters generated using PAS. This exercise will be conducted in
line with national best practice, and the Trust will continuously review its processes