Document Title and Version Number
Patient Access Policy Version 2.0
Scope:–
This Policy describes how the Trust will manage Access to its services and ensure fair treatment of all patients.
It is available on Public Folders and on the Princess Alexandra Hospital Website
All staff and patients are required to comply with the requirements of this Policy and should have a clear understanding of their role and responsibilities.
Purpose/ Key Points:-
The Princess Alexandra Hospital NHS Trust endeavours to treat all patients with equity, honesty and in line with the NHS Constitution.
The successful management of patients who are waiting for treatment is the responsibility of all organisations within the whole West Essex and Hertfordshire Health System and the length of wait is a public indicator of the equity and efficiency of the hospital services provided by the Trust.
This Policy and associated guidance defines the principles and establishes best practice guidelines to assist staff with the effective management of Outpatient, Inpatient and Day Case waiting lists.
Patient Access Policy
Signed ……….. ……… Chair of Governance Committee
Version: 2.0
Ratified by: Governance Committee Date ratified:
Name of originator/author: Rebecca McGinley Name of responsible individual
(sponsor) and committee (If appropriate):
Batsirai Katsande – Head of Operations - Clinical Support Services
Director Responsible Jules Martin – Chief Operating Officer Date issued:
Review date: July 2014
Name of reviewer: Louise Jones, Bernadette Roach, Julie Matthews, Stephen Fry, Helen Leslie, Peter Leslie, Allan Zeller, Mags Farley, Rob Duncombe, Heather Keoghoe, Victoria Gilbert, Penny Griffiths, Sue Peters, Melanie Crass.
Target audience: PAHT / West Essex and Hertfordshire Health Economy
Related Document 1) Referral to Treatment Consultant Led Treatment Times – Rules Suite – January 2012
2) The Operating Framework for the NHS in England 2012/13
Contents Page
1 Executive Summary 7
1.1 Key Principles 7
2 NHS Constitution 9
3 Expectations and Responsibilities of Staff and NHS Patients 10
3.1 The Trust Chief Executive 11
3.2 Trust Directors and Medical Directors 11
3.3 Heads of Operations 11
3.4 Trust Managers 11
3.5 All Trust Staff 11
3.6 Clinicians 12
3.7 Referrers 12
3.8 NHS Patients 12
4 Referral to Treatment (RTT) Pathways 13
4.1 RTT Performance Monitoring 13
4.1.1 RTT Clock Starts 13
4.1.2 RTT Ongoing Clocks 13
4.1.3 RTT Clock Stops 13
4.1.4 Patients not on an RTT Pathway 13
4.1.5 Social Unavailability 13
5 Process for Monitoring Compliance and Effectiveness 14
6 Outpatient Management 16
6.1 Referrals 16
6.1.1 Choose and Book Pooled Service 16
6.1.2 Process for Referral Rejection 16
6.1.3 GP Referrals to Named Consultants 16
6.1.4 Time frames for Receiving Referrals 16
6.1.5 Referrals via Clinical Review Service (CRS) 17
6.1.6 Accurate Demographics Recording 17
6.2 Inappropriate Referrals 18
6.2.2 Consultant Rejection 18
6.3 Suspected Cancer Referrals 18
6.3.1 Cancer Waiting Time Standards 2012/13 18
6.3.2 Best Practice for Referrals 19
6.3.3 Patient Unavailability 19
6.3.4 Patient Failure to Attend 19
6.3.5 Referrals Upgrades 19
6.3.6 Referral to MDT Meeting 19
6.3.7 Timeframes for Treatment Pathways 20
6.3.8 Patient Tracking and Navigation 20
6.4 Rapid Access Chest Pain Clinic Referrals 20
6.5 Overseas Visitors 20
6.6 Private Patients 20
6.6.1 NHS Patients who Convert to Private Status 20
6.6.2 Private Patients who Convert to NHS Status 21
6.7 War Veterans 21
6.8 Management of Referrals using Choose & Book 21
6.8.1 Patient Choice of Provider 21
6.8.2 Out-Patient Capacity Monitoring 21
6.8.3 Directly Bookable Appointments 21
6.9 Arranging Outpatient Appointments 22
6.9.1 Timeframes for First Attendance Out-Patient Appointment 22 6.9.2 Patient Unavailability for First Attendance Out-Patient Appointment 22
6.10 Failed Appointments 23
6.10.1 Failure to Attend First Appointment 23
6.10.2 Failure to Attend Follow-up Appointment 23
6.10.3 Out-Patient Capacity Monitoring 24
6.11 Patients who cancel an Out-Patient Appointment 24
6.11.1 Cancellation of First Appointment 24
6.11.2 Cancellation of Follow-up Appointment 24
6.12 Patients who are Cancelled by the Hospital 25
6.13 Reconciling Out-Patient Clinics 25
6.15 Review Lists 25
7 Diagnostics 27
7.1 GP Direct Access to Diagnostic (not part of RTT Pathway) 27
7.1.1 Direct Access Radiology Diagnostics Pathway 27
7.1.2 Patient Failure to Attend Appointments 27
7.1.3 Patient Cancellation of Appointment 27
7.1.4 Hospital Cancellation of Appointment 28
7.1.5 Last Menstrual Period (LMP) Patients 28
7.2 Consultant Led Diagnostics (Patient who are on RTT Pathway) 28
7.2.1 Timeframes for Consultant Led Diagnostics 28
7.2.2 Patient Unavailability 28
7.2.3 Patient Failure to Attend Appointments 28
7.2.4 Patient Cancellation of Appointments 29
7.2.5 Hospital Cancellation of Appointments 29
7.3 Endoscopy Referrals 29
7.4 Direct Access Audiology 29
7.4.1 Timeframes for Audiology Appointments 29
7.4.2 Patient Unavailability 29
7.4.3 Patient Failure to Attend Appointments 30
7.4.4 Patient Cancellation of Appointments 30
7.4.5 Hospital Cancellation of Appointments 30
7.5 Consultant Led Audiology Diagnostics 31
8 Inpatient Waiting List Management 32
8.1 Adding Patients to a Waiting List 32
8.2 Treatment of Limited Clinical Effectiveness (TOLCE) 33
8.3 Offering To Come In (TCI) Dates 33
8.3.1 Short Notice Offers of TCI Date 33
8.3.2 Process for Contacting Patients to Offer TCI Date 34
8.3.3 Patient Refusal of TCI Date 34
8.3.4 Patient Unavailability 34
8.3.5 Exceptions to the Guidance 34
8.4 Medically Unfit Patients 34
8.4.1 Management of Fitness 34
8.4.2 Referrals Back to GP for Medically Unfit Patients 35
8.5 Patients Who Do Not Attend (DNA) for TCI Date 35
8.6 Patient TCI Date Cancellation 35
8.7 Hospital Admission Cancellation 36
8.8 Suspensions 36
8.9 RTT Pauses for Social Reasons 37
8.9.1 Maximum 10 Week Period for Social Suspension 37
8.9.2 Removal from the Waiting List for Social Periods in Excess of 10 Weeks 37 8.9.3 Process for Re-Listing Following Wait List Removals 37
8.10 Transfers Between Healthcare Providers 37
8.11 Outsourcing 38
8.12 Pre-Op Assessment Clinics (POA) 38
8.12.1 MRSA Swabbing 38
8.12.2 Confirmation of Patient Fitness for Surgery 38
8.12.3 Patient Failure to Attend for POA 38
8.12.4 Patient Cancellation of POA 38
9 DNA Policy for Children and Young People 40
10 Missed Appointments for Children and Young People 40
10.1 Guideline Statement 40
10.2 Impact on Children 40
10.3 Aim of the Guidance 41
10.4 Practitioner Requirements 41
10.5 Action to be Taken 41
11 Management Information 43
11.1 Information for Hospital Management 43
11.2 Information to GP’s 43
11.3 Information to the Strategic Health Authority 43
12 Training 44
1 Executive Summary
This policy describes how the Trust will manage access to its services and ensure fair treatment of all Patients. The successful management of waiting lists is key to achieving National objectives in reducing waiting times and improving Patient Choice and therefore takes in to account current Guidance from the Department of Health, The National Framework for the NHS which includes the NHS Constitution.
The successful management of patients who are waiting for treatment is the responsibility of all organisations within the whole West Essex and Hertfordshire PCT Cluster health system. Everyone involved in Patient Access should have a clear understanding of their role and responsibilities including the Patient. This policy defines the principles and establishes best practice guidelines to assist staff with the effective management of Outpatient, Inpatient and Day case waiting lists.
The length of time a patient waits for hospital treatment is a significant quality and clinical governance issue. It is also a visible and public indicator of the equity and efficiency of the hospital services provided by the Trust.
1.1 Key Principles
The key principles of the Princess Alexandra Hospital Trust Patient Access policy are that: 1.1.1 All Patients will be treated with equity, honesty and in line with reasonable
guidelines in a fair and equitable manner regardless of age, disability, gender reassignment, marriage or civil partnership, race, religion or belief, sex and sexual orientation.
1.1.2 Patients will be treated in order of their clinical need. Where Patients have the same or comparable clinical need, they will be treated in chronological order, thereby minimising the time a patient spends on the waiting list and improving patient experience
1.1.3 Patients must only be added to the waiting list if they are fit; ready and available to come in at the time the Decision to Add to the Waiting List is made.
1.1.4 Patients will be given the opportunity to have a choice of date for their Outpatient Appointment/Admission date
1.1.5 All waiting lists must be managed on the Trust’s Patient Administration System (PAS) system or Electronic Patient Record (EPR) and all information relating to Patient activity must be recorded accurately and in a timely manner
1.1.6 Processes will support the reduction in waiting times, reduction in cancelled operations and the achievement of the Trust’s patient access standards
1.1.7 The Trusts Directory of Services will be kept up to date and fit for purpose and sufficient electronic slots available on the Choose and Book system for patients choosing PAH as their health care provider
1.1.8 The concept of waiting lists for the different stages of treatment (outpatient, diagnostic, and inpatient) has been replaced by Referral to Treatment pathway (RTT). RTT treats the patient’s journey from receipt of referral to first definitive treatment as one joined-up waiting time.
1.1.10 The RTT clock most commonly starts at receipt of GP referral and can also start at the end of a period of active monitoring when a decision that treatment is now appropriate, is made
1.1.11 For patients who are electronically booking via the Choose and Book system the clock starts when the UBRN (Unique Booking Reference Number) is activated i.e. converted into a booking
1.1.12 Patients who are attempting to book through the TAL (The Appointments Line) and are unable will have their clock start time when the UBRN is received within the Trust
1.1.13 If a patients referral is rejected the clock remains ticking
1.1.14 Routine, Urgent and 2 Week Wait 1st outpatient appointments only are available on the Choose and Book system
1.1.15 The clock stops when a clinical decision is made that treatment is not required, when a patient declines treatment, or when first definitive treatment begins
1.1.16 Directorate and Service Managers are responsible for ensuring the implementation of process and guidance as set out in the Policy
1.1.17 Action cards to aid training and explain processes for staff will be available for review in individual departments
2 NHS Constitution
The NHS Constitution sets out the rights of an NHS patient. These rights cover how a patient can access health services, the quality of care received, the treatments and programmes available to all patients, confidentiality, information and the right to complain if things go wrong.
Since 1 April 2010, the following rights apply to an NHS patient under the NHS Constitution:
1) To start non-emergency treatment within a maximum of 18 weeks from receipt of referral.
Exceptions; the right will cease to apply in circumstances where: Patients choose to wait longer;
Delaying the start of treatment is in the patients best clinical interests, for example where smoking cessation or weight management is likely to improve the outcome of the treatment;
The patient fails to attend an appointment which has been chosen from a set of reasonable options;
The following services are not covered by the right:
Non-medical consultant-led mental health services; and Maternity services.
2) To be seen by a specialist for suspected cancer within 2 weeks of an urgent GP referral Where this is not possible, the NHS is to take all reasonable steps to offer a patient an alternative provider, unless it is not clinically appropriate or the patient chooses to wait longer.
3 Expectations and Responsibilities of Staff and of NHS Patients
It is vital that this policy is both fully supported by Trust staff and that patients are involved in their care and play a role in accessing their right to treatment. The following expectations and responsibilities are therefore required of all Trust staff and patients alike:
3.1 The Trust Chief Executive
The Trust Chief Executive is responsible for ensuring that this policy is fully supported by all staff and that there are sufficient resources available to enable its full implementation. 3.2 Trust Directors and Medical Directors
All trust directors are responsible for ensuring that managers enable staff to comply fully with this policy and that they have appropriate resources to do so.
3.3 Heads of Operations
The Heads of Operations and Heads of Nursing are responsible for ensure policy compliance within their areas of responsibility. The Heads of Operations and Nursing are responsible for ensuring that the policy is brought to the attention of all new staff at induction, that there is adequate capacity and capability to fulfil the requirements of the Access Policy and for reviewing this policy.
3.4 Trust managers
All trust line managers are responsible for ensuring that the staff who report to them comply fully with this policy.
All trust line managers are responsible for fully supporting any members of staff who require training to ensure all staff within their area of responsibility are aware of the access policy and how it should be implemented within their individual roles. All trust managers are responsible for monitoring the policy in their department and ensuring that their department is adhering it.
Managers will be responsible for disciplining staff who breach this policy.
Non-compliance with the Trust policy should result in managers taking disciplinary and performance management action.
All trust line managers are responsible for fully supporting staff who bring this policy to the attention of any person in breach of it.
3.5 All Trust Staff
All trust staff have a duty to comply fully with this policy.
All trust staff are responsible for their own training so they fully comply with the policy.
All trust line staff are responsible bringing this policy to the attention of any person in breach of it.
Waiting List administrators are responsible for the day-to-day management of their lists and are supported in this function by the Service Managers and Heads of Operations and Heads of Nursing who are responsible for achieving access targets in their areas of responsibility.
Heads of Operations through Service Managers are responsible for ensuring all waiting list data is accurate and the policy is complied with.
The Head of Information is responsible for the reporting of information to the Medical Directors, monitoring performance against locally or nationally agreed targets and ensuring this is fed into appropriate operational and performance forums.
The Head of Information is responsible for providing regular data quality audits of standards of data collection and recording the submission of central returns produced by the Information Department.
3.6 Clinicians
All clinicians are responsible for complying with annual leave and study leave policies to ensure a minimum of six weeks’ notice is given for all annual leave and study leave requests.
Clinicians are required to provide clinical judgement on further management of patients following a DNA or multiple patient cancellations.
All clinicians are responsible for effectively managing their waiting lists and patient waiting times in accordance with the maximum guaranteed waiting times and RTT pathway.
All clinicians are responsible for ensuring patients are not listed unless medically fit and ready for procedure.
3.7 Referrers
Referrals must ensure that referrals are clear and contain the minimum data set required to process effectively and efficiently.
GPs are responsible for playing a pivotal role in ensuring patients are made aware during their consultation of the likely waiting times for a new outpatient consultation and of the need to be contactable and available when referred.
GPs are responsible for ensuring that patients placed on a urgent care pathway are aware of the reasons and urgency of the referral.
The Primary Care Trust (PCT) is responsible for ensuring robust communication links are in place to feedback information to GPs.
3.8 NHS Patients
It is vital that patients must inform the hospital of any changes to their name, address, telephone number or GP to ensure all correspondence reaches them. Patients should keep their appointments, and make every effort to arrive on time. If the patient cannot attend, they should inform the hospital with as much notice as possible.
Patients must inform their GP if their medical condition improves or deteriorates in any way which may affect their attendance.
Patients who know that they will be unavailable for any period of time and therefore will not be able to attend an appointment or admission should inform the hospital with as much notice as possible
Patients who no longer wish to have their outpatient appointment or admission, for whatever reason, must advise either their referrer or the hospital appointment office.
Patients are encouraged to ask staff about any aspect of their care and the steps towards their treatments
Patients are encouraged to feedback comments or suggestions regarding their experience and our services at the Trust
Patients are encouraged to ask Clinical staff any questions they have regarding their condition, treatment or support before leaving the hospital.
4 Referral to Treatment Pathway (RTT)
4.1 RTT Performance Measures
Performance will be monitored in line with the Operating Framework as published by the Department of Health.
Terminology:
4.1.1 RTT Clock Starts
A clock start is most commonly started when a referral is received in a consultant led service for diagnosis and treatment of a patient’s condition. An RTT Clock Start can also be generated following a Consultant to Consultant referral for a condition unrelated to the original referring condition. A RTT Clock can also start at the end of a period of active monitoring when a decision that treatment is now appropriate is made. This is therefore a new RTT Pathway, in which a patient must receive their first definitive treatment.
4.1.2 RTT Ongoing clocks
A patient’s clock is ongoing up to the point of first definitive treatment. This ongoing stage of a patient’s pathway includes all investigation and diagnostics as well as waiting for procedure dates on the In-Patient Wait List.
4.1.3 RTT Clock Stops
An RTT Clock is stopped when first definitive treatment begins that is intended to manage a patients condition (such as medication prescribed at Out-patients or Elective Procedure) or a clinical decision is made that treatment is not required or a clinical decision is made where it is appropriate to monitor the patient in secondary care.
4.1.4 Patients not on an RTT Pathway
Many patients continue to have ongoing treatment after their first initial treatment, sometimes for many years for the same chronic condition. Once a patient has received their first definitive treatment any further (such as follow-up Out-Patient appointments) is called non-RTT activity. Patients that also attend for planned surveillance diagnostic activity is also not part of a RTT Pathway.
4.1.5 Social Availability
Under RTT rules, patients referred into the Trust should be socially available to commence treatment. As this is not always the case, there are a number of ways in which patient compliance can affect their RTT referral to treatment pathway. Such details are set out throughout this Policy.
5 Process for Monitoring Compliance and Effectiveness
It is the responsibility of all Clinical Leaders and Senior Managers to ensure the implementation of this policy, as set out below:
5.1 The RTT week maximum waiting time from referral to first definitive treatment requires a whole system approach to capturing the stage the patient has reached within their treatment and communicating this between organisations (since the start of the RTT journey may be in one trust transferring to another) and also across the Trust as a whole.
5.2 The completion of Clinical Outcome Forms by clinicians within Outpatients is imperative for the Trust to understand the patient pathways and to be able to monitor the waiting times at each stage
5.3 Issues regarding completion of Clinical Outcome Forms for individual specialities will be identified by the Trust RTT Validation Team and highlighted to the speciality Operational Manager for resolution.
5.4 Operations Managers/Heads of Service receive weekly RTT Review list of patients without Clock Stops. It is their responsibility to ensure that patient pathways are investigated and corrective action identified and the RTT Validation Team are informed. Any errors in completion of Clinical Outcome Forms must be highlighted with the relevant medical teams.
5.5 Operational Managers are responsible for ensuring correct processes are in place for Medical and Nursing staff to record all out of clinic clinical decisions that affect Treatment Status are recorded onto PAS
5.6 Heads of Operations, Heads of Nursing, Heads of Service and Operational Managers are required to review the content of this policy and ensure robust operational procedures are in place to manage the Outpatient, Diagnostic and Inpatient/Daycase Priority Target Lists (PTL’s).
5.7 The DNA rates for clinics will be monitored and incorporated into the Business Unit’s performance reports. DNA rates should be bench marked locally with other similar clinics and nationally where appropriate.
5.8 Issues resulting in poor implementation of the Patient Access Policy will be identified by the RTT Validation Team, the Information Dept, and any Dept involved in patient pathways to the Elective Managers, Patient Contact Centre.
5.9 Identified errors in patient pathways need to be escalated to the Elective Managers, Patient Contact Centre, who will identify the staff who require extra training regarding implementation of the Patient Access Policy
5.10 The Trust Information Department will provide a weekly updated PTL report to enable staff to date elective patients within their RTT Pathway
5.11 Effective implementation of the Trust’s 6 weeks notice for the booking of Consultant annual leave will be monitored by the Clinical Director of each Business Unit to
ensure the short notice cancellation of Consultant’s Outpatient clinics due to annual leave are an exception.
5.12 The Trust will monitor patient and hospital cancellation to minimise cancellations and improve patient experience.
6 Outpatient Management
6.1 Referrals
This section sets out the responsibilities of the referring clinician and those of the staff members processing referrals upon receipt into the Trust.
6.1.1 Choose and Book Pooled Service
For Choose and Book (C&B) referrals the Trust provides a pooled service and the patients are able to choose the next available appointment within the specialty required. However if there is a specific need for the patient to see a particular Consultant the referring GP can select the named clinician.
6.1.2 Process for Referral Rejection
For referrals that have been booked into an inappropriate specialty, the referral will be rejected and rejection information including the most appropriate course for the patient will be documented on Choose and Book.
All referral letters must be attached to the Choose and Book referral by the referring clinician within three days (for routine referrals) of the referral being made and the receiving specialty must review the letter within seven days of receiving it and action it on the Choose and Book system. If the letters are not attached, it may lead to the patient being returned to the care of the GP and being unable to have their consultation at their Out Patient Appointment.
6.1.3 GP Referrals to Named Consultants
Where appropriate, GPs should be encouraged to use open or generic letters which will be allocated to the appropriate Consultant within that special interest who has the shortest waiting time. To support this, the Trust will electronically publish Outpatient Specialty waiting times made available to all GP’s on the Choose and Book system.
GPs must retain the flexibility to refer to a named consultant but the Trust may need to transfer this patient to another consultant if the named consultant would exceed their maximum waiting time target.
It is the responsibility of the Referrer to ensure that the referral letter contains accurate and up to date demographic information regarding the Patient, including NHS number and both daytime, evening and mobile phone contact numbers.
6.1.4 Timeframes for Receiving Referrals
The Patient Contact Centre, PCC, is the central point of contact for all referral letters. There should not be a delay of more than 5 working days from the GP taking the decision to refer, to the referral being received at the Trust and there should not be a delay of more than 10 working days if the referral is received via the CRS (Clinical Review Service). The contract standard is for the CRS to pass 90% of referrals within 1 week and 100% within 2 weeks.
If paper referrals are received from West Essex PCT for the agreed specialties having not firstly been triaged through the CRS with a date stamp, they will be sent to CRS for triaging. Therefore only paper referrals for the agreed specialties with a West Essex stamp will be processed.
Referrals must be date stamped on the day that they are received within the Trust and this date used when entering the patient onto the Registered Referral list on PAS. This date is then used as the start point for calculating the patient’s RTT pathway.
All referral letters should be logged on the PAS within 1 working day and graded, or rejected within 7 working days of receipt.
6.1.5 Referrals via Clinical Review Service (CRS)
For patients that have been referred through the CRS and see a GP with Specialist Interest (GPSI) where no treatment is commenced and an onward referral to Secondary Care is required, the RTT clock start date will be at the point of first UBRN conversion. Any breaches as a result of delays in the GPSI pathway will be recorded as a shared breach. At present when onwardly referred they are as paper referrals as the GPSI clinics are not electronic so each paper referral will require a Minimum Data Set Form (MDS) stipulating this 1st UBRN conversion date.
For patients that have been referred through the CRS and seen in a GPSI where treatment has been commenced and an onward referral to Secondary Care is required, the RTT clock start date will be at the date of the receipt of referral into the Trust. An MDS form stipulating the first UBRN conversion date will accompany the referral letter.
For patients that have been referred from the CRS directly into Secondary Care, the RTT clock start date will be the conversion of the 2nd UBRN if via Choose and Book or date of receipt of referral into the Trust if by paper.
6.1.6 Accurate Demographic Recording
It is the Trust’s responsibility to ensure demographic details are used when arranging appointments and to update PAS accordingly. It is also the Trust’s responsibility to check those details using the Demographic Batch Service to maintain communication with the Patient in order to reduce wasted appointments.
It is the responsibility of the Patient to communicate with the Trust if their circumstances change i.e. changes of address, contact telephone number or General Practitioner. It is the responsibility of the GP to explain this responsibility to the patient.
All Out-patient clinics are directly bookable and are available on the Trust Electronic Directory of Services.
Key Data Input:
The Referral date entered on PAS must always be the date the letter is RECEIVED and date stamped at the receiving Trust, even if the referral has been transferred from another provider. This date must never be changed.
6.2 Inappropriate Referrals
This section details the process for managing inappropriate referrals received into the Trust.
6.2.1 Inappropriate Referral - Specialty Rejection
If a Consultant deems a referral to be inappropriate, it must be sent back to the referrer with an explanation why. The referral must be updated accordingly on PAS.
If an electronic referral has been reviewed by the Consultant and is inappropriate for the specialty selected, the referral will be rejected. This clears the booking out of the PAS and the Choose and Book system and the duty of care for the patient is returned to the GP who must inform the patient. When rejecting a patient a full explanation must be given and entered onto Choose and Book.
6.2.2 Inappropriate Referral – Consultant Rejection
If a referral has been made and the special interest of the Consultant does not match the needs of the patient, the Consultant should cross-refer the patient to an appropriate colleague where such a service is provided by the Trust and the referral amended on PAS. This cross-referral does not then constitute a new Consultant to Consultant referral; the original referral details must be changed to reflect the change of Consultant / specialty and original RTT Clock Start information.
6.3 Suspected Cancer Referrals
6.3.1 Cancer Waiting Time Standards 2011/12
14 Day Urgent GP Referral to 1st Appointment – No more than 14 days. 62 Day Urgent GP Referral to Treatment – No more than 62 days.
31 Day for all confirmed cancers, from Decision-to-Treat to First Treatment.
Breast Symptomatic GP Breast Symptomatic Referral to 1st Appointment – no more than 14 days.
National Standard:
Clinical Priority should be defined as Urgent or Routine only
The Sub-Specialist nature of the referral must also be recorded (Ref: DSCN 34/2003)
National Standard:
The NHS Constitution stipulates that patients have the right to access services within maximum waiting times for suspected Cancers this is 2 weeks (14 days). Where this is not possible the Trust will take all reasonable steps to offer a quicker appointment at a range of alternative providers if the patient makes a request.
Subsequent Treatments – no more than 31days from date patient is fit for treatment
Consultant Upgrades – from upgrade to Treatment – no more than 62 days.
6.3.2 Best Practice for Referrals
For a GP Referral where cancer is suspected, the preferred method of referral is via the Choose and Book Two Week Wait Service which allows high risk patients to leave the surgery with their electronically booked appointment. The pro-forma must be attached to the URBN number within 24hours.
GPs may also choose to send a paper referral which can be faxed to The Patient Contact Centre. All Patients will be contacted within 24 hours of receipt of the referral to be offered an appointment within the 2 week period; this will then be registered on both the CIS Infoflex (Cancer Information System) and PAS system.
Patients can only be removed from the 62 Day pathway by the referring GP. If a Consultant feels a referral is inappropriate they can have discussion with the GP to determine if an alternative referral pathway could be more appropriate.
6.3.3 Patient Unavailability
If a patient is offered a 2 Week Wait appointment within 14 days, but requests the appointment to be rearranged on 2 or more occasions and over 21days following receipt of referral, the patient may be referred back to their GP. The urgency of the appointment will be discussed at every contact with the patient, and the Hospital will actively encourage the patient to make every effort to attend within a reasonable time period.
Any patients being returned to their GP will be informed, and the GP will be contacted within 24 hours informing them of their patients’ decision.
6.3.4 Patient Failure to Attend
Suspected cancer patients should not be referred back to the GP if they do not attend for their first outpatient appointment. A further appointment will be made and the RTT clock restarted when the patient accepts the reappointment. The Multi Disciplinary Team (MDT) Coordinators will ensure a new appointment is made within 7 days.
Suspected cancer patients can be referred back to their GP after multiple (2 or more) DNAs. MDT Coordinator to process referral back to GP.
6.3.5 Referral Upgrades
Where a patient, who is not an urgent GP referral, is suspected of having cancer, then the Consultant (or authorised member of the Consultant team) can upgrade the patient to a 62 Day pathway, and the MDT Coordinator notified.
6.3.6 Referral to MDT Meeting
If diagnostics indicate a cancer, the patient will be discussed at an MDT meeting, where diagnosis will be confirmed and treatment options agreed. The treatment options will be presented to the patient in clinic.
6.3.7 Timeframes for Treatment Pathways
Once a treatment option with the patient has been agreed, treatment will take place quickly to:
Within 31 days of decision to treat and/or
Within 62 days of receipt of the urgent GP referral.
6.3.8 Patient Tracking and Navigation
Patients will be tracked / navigated along the care pathway, in line with the rules, principles and spirit of national guidance, so ensuring that all patients who are willing and able will be treated within the national waiting time standards.
6.4 Rapid Access Chest Pain Clinic Referrals National Standard:
No Patients referred through the RACP process should wait more than 14 days from being referred to date first seen.
Patients referred through the RACP process are responded to immediately providing the referral is received within 24 hours.
In order for a Referral to be treated as urgent, the correct pro-forma must be used by the referrer.
6.5 Overseas Visitors
An Overseas Visitor’s right to receive NHS Care must be verified prior to that care being given. The NHS has reciprocal agreements with some countries that entitle the Patient to limited access to Emergency and Elective Healthcare provision. If an Overseas Visitor is entitled to receive treatment, a Department of Health Overseas Visitors Form must be completed for each attendance / admission that they attend, which the Overseas Visitor Liaison will supply.
Separate Trust Guidance should be referred to when managing the treatment of overseas visitors, as access to Health Services may be limited.
6.6 Private Patients
6.6.1 NHS Patients who convert to Private Status
Patients who choose to leave NHS-funded care and to fund their own care in the private sector will have an RTT Clock stop applied on the date that the patient informs the provider of this decision.
For patients who are treated in the private sector under NHS commissioning arrangements (i.e. they are NHS patients whose care has been funded by the NHS and commissioned by the NHS from the private sector), the RTT Clock continues to run until the first definitive treatment.
6.6.2 Private patients who convert to NHS Patients
For patients who are seen privately but then transfer to the NHS, where the patient has not been treated in the private sector, the RTT clock should start at the point at which the clinical responsibility for the patient's care transfers to the NHS. I.e. the date when the referral is accepted or the date at which the patient is added to an NHS Waiting List. Where a patient has been treated in the private sector and is transferring to the NHS for monitoring then this is not part of an RTT pathway.
Patients can choose to convert between an NHS and Private status at any point during their treatment without prejudice.
6.7 War Veterans
War Veterans will receive priority access to NHS Secondary Care for any condition which is likely to be related to their service, subject to the clinical needs of all patients. GPs should notify the Trust of the patients’ condition and its relation to military service when they refer the patient so that the Trust can ensure that it meets the current guidance for priority service over other patients with the same level of clinical need.
6.8 Management of Referrals using Choose and Book
This section details the functionality of the Choose and Book system.
6.8.1 Patient Choice of Provider
The current release of Choose and Book is Version 5.02. It is nationally commissioned and built by Atos Origin to provide the NHS with an electronic booking and choice tool.
The introduction of free choice means that patients referred to see a specialist will be able to choose where they are treated from a national menu of hospitals that meet the NHS standards.
6.8.2 Out-Patient Capacity Monitoring
The services currently available for direct booking have a slot polling length (number of weeks outpatient appointment slots can be seen ahead) and vary depending on Specialty. The Trust continues to monitor the slot availability to ensure there is sufficient capacity for electronic booking and to ensure that our Appointment Slot Issues (ASI) remain below 4%.
6.8.3 Directly Bookable Appointments
An Electronically Bookable Service, EBS, is one where the referrer can book the patient electronically into a published appointment slot in the Patient Administration System (PAS) via Choose and Book. If the referrer does not complete an electronic booking during their consultation, the referrer could send the patient to the practice reception to complete their booking, or the patient could go home to think about the choices and then call the Choose and Book Appointment Line (TAL) or access the internet to complete their booking.
Patient Contact Centre staff will manage electronic referrals for some specialties until they increase to a level when Consultants and their teams will be expected to manage their
own electronic referrals using the Choose and Book system. The PAH interim process guide explains how electronic referrals are managed by central appointment staff.
Currently in West Essex there is Central Referral Service (CRS) where referrals are triaged for appropriateness to secondary care.
6.9 Arranging Outpatient Appointments
This section details a patient’s access to Outpatient appointments.
6.9.1 Timeframes for 1st Attendance Outpatient appointment
For Directly bookable appointments sufficient electronic slots must be viewable on the Choose and Book system for patients to choose and select their routine appointment electronically. Patients must be available to book their appointment within five weeks of the decision to refer.
All Patients will be offered appointments within the current guidelines for Patient Choice and within the maximum waiting times. The patient will be contacted by the hospital within 10 days of receiving the referral letter, either by phone call or “Phone Me” letter. “Phone Me” letters will stipulate that if a patient does not contact the Patient Contact Centre within 7 working days of receipt of the letter, they will be discharged back to the care of their GP. 6.9.2 Patient unavailability for 1st Attendance Outpatient appointment
All patients will be offered Outpatient Appointments within the current guidelines for Patient Choice and the RTT Pathway. Where Patient’s refuse a reasonably offered appointment, with at least 2 weeks notice, and they are not able to accept another appointment within 2 weeks of the initially offered appointment, they will be discharged and returned to their GP. Urgent referrals must be given priority. Heads of Operations and Heads of Service and Consultant should review clinic templates regularly to ensure the number of slots reserved for Urgent patients reflect the current demand.
National Standard:
From the 1st April 2008 Patients should not have to wait more than 5 weeks from referral to date first seen.
Local Standard:
From the 1st April 2008 Patients should not have to wait more than 5 weeks from referral to date first seen.
National Standard:
For a written appointment offer to be deemed reasonable, the Patient will be offered an appointment with a minimum of three weeks notice.
For a verbal appointment offer to be deemed reasonable, the Patient will be offered a choice of two appointment dates with a minimum of three weeks notice to the first date.
Local Standard
A reasonable offer written or verbal must have a minimum of two weeks notice.
6.10 Failed Appointments Local Standard:
The percentage of Patients who Do Not Attend a First Outpatient Appointment should not exceed 4% of the total number of patients with outpatient’s appointments.
For follow-up appointments, the DNA rate should not exceed 7%
Local Standard:
Where a Patient fails to attend an agreed and reasonably offered First Appointment date, they should be returned to the care of their GP, on the first occasion
This section sets out the pathway for patients who change on the day or fail to attend patient appointments.
6.10.1 Failure to Attend First Appointment
Patients with a First Appointment, who DNA, will be discharged back to their GP.
For electronically booked patients who DNA, the Choose and Book system must be accessed and actioned as “return to referrer for follow-up”. This action will be carried out by the Patient Contact Centre and the patient can only book a further New Appointment via their GP.
Patients with a Routine First Appointment who contact the hospital on the day of their appointment to say they are unable to attend will be offered another appointment the following week. If they are unable to accept this offer of a new appointment they will be discharged back to their GP.
Children and Vulnerable adults (a person of above 18 years of age in need of services who, by reason of mental or other disability, age or illness may not be able to take care of him or herself, or is unable to protect him or herself against significant harm or exploration) are the exception to the above and they will be offered 1 New appointment date if they DNA. The RTT clock will be stopped at the DNA and restarted on the subsequent follow-up appointment date is offered. Please see Section 3 DNA/missed appointments Children and Young people.
Urgent and Cancer Wait Target patients are the exception to the above and they will be offered a further New appointment if they DNA.
6.10.2 Failure to Attend Follow-Up Appointment
If a patient DNA’s a follow up appointment, the patient will be discharged back to their GP. Where an exceptional clinical circumstance exists, GPs will be able to contact the Patient Contact Centre (PCC) to agree a direct re-referral for a follow-up appointment if required. Children, Vulnerable adults (as describe in section 6.10) Urgent and Cancer Wait Target patients are the exception to the above and they will be offered a further follow-up appointment if they DNA. The RTT clock will be stopped at the DNA and restarted on the subsequent follow-up appointment date is offered. Please see Section 3 DNA/missed appointments Children and Young people.
6.10.3 Outpatient Capacity Monitoring
The DNA rates for clinics will be monitored and incorporated into the Trust’s performance report. DNA rates will be bench marked locally with other similar clinics and nationally. 6.11 Patients who cancel an Outpatient Appointment
This section outlines the pathway for patients that cancel Outpatient appointments. 6.11.1 Cancellation of First Appointment
If patients with an agreed First Appointment contact the hospital to cancel and change the appointment they must be offered an appointment within 10 weeks of the date of receipt of their referral. If the patient is unable to agree a date within a 10 week period they should be discharged back to the GP. They should be referred back to the Trust by the GP when they are ready and available.
If there is no clinic capacity to allow this the PCC staff must escalate to the appropriate Service Manager of the Speciality their RTT clock continues from their original date of referral.
If a patient cancels two consecutive First Appointments their RTT clock will stop and the patient will be discharged back to the care of their GP.
If a patient cancels an appointment through the Choose and Book system and fails to re-book a further appointment within 2 weeks of the cancelled appointment date, the UBRN number will be automatically closed by the Hospital.
Patients should be referred back to the Trust by their GP once they are available to complete the full RTT Pathway.
6.11.2 Cancellation of follow-up Outpatient appointment
If a patient contacts the hospital to cancel and re-arrange a Follow-up appointment, clerical staff must check the Treatment Status on PAS of the patient to establish if active on the RTT Pathway or if beyond RTT.
If the patient is still active on the RTT Pathway they should be asked to agree to an appointment within 2 weeks of the date they wish to change. Their RTT clock continues from their original date of referral. If the patient is unable to agree a date within a 2 week period they should be discharged back to the GP. If there is no clinic capacity to allow this, the PCC staff must escalate to the appropriate Service Manager or Specialty.
If the patient is still active on the RTT Pathway and contacts the hospital to re-arrange a Follow-up appointment for the second consecutive time, their RTT clock will stop. If the patient is unable to agree a date within a 5 week period they should be discharged back to the GP. If the patient is identified as beyond RTT they may agree another Follow-up appointment for a date and time that is convenient for them.
When a Patient cancels their appointment and does not wish to arrange another, they should be discharged back to the care of their GP.
6.12 Patients who are cancelled by the Hospital
Clinics should not be cancelled with less than six weeks notice to ensure Hospital Cancellations are minimised. The Trust’s Medical staff Leave Policy must be applied in all situations to support this.
If the hospital cancels a patient’s outpatient appointment they must check if the patient is active on the RTT pathway or beyond RTT.
If the patient is active on the RTT pathway they must be offered another appointment within 2 week of the original cancelled appointment. If there is no clinic capacity to allow this the PCC staff must escalate to the appropriate Service Manager of the Speciality. The RTT week clock continues from their original date of referral.
If the patient is identified as beyond RTT they may agree another appointment for a date and time that is convenient for them.
6.13 Reconciling Outpatient Clinics Local Standard:
The outcomes and Treatment Status for all outpatient clinics must be recorded on the Patient Administration System in real time.
The Outcome and Treatment Status for Patients attending an Outpatient clinic should be recorded according to the Recording Outpatient clinic Outcome process. Outcomes must be accurately recorded to reflect a patient’s current Treatment Status.
Any incomplete “Outpatient Status and Clinical Outcome forms” must be returned to the appropriate clinician for completion by Outpatient Clinic staff.
6.14 Transfers between Healthcare Providers
The Decision to transfer patients to alternative providers must be with the consent of both the Patient and the GP/GDP (General Dental Practitioner). Patients not wishing to be transferred must still be seen within the RTT Pathway.
All patients transferred to another Healthcare Provider must have either a Minimum Data Set (MDS) form or a Constitution Minimum Data Set (CMDS) completed to confirm the patient’s clock start on the RTT pathway. This MDS must be sent to all other providers as part of the patient’s referral paperwork.
If a patient is receiving Physiotherapy at another provider, the referral form must include a patient’s clock start date to allow the other provider to accurately monitor the patient pathway.
6.15 Review Lists
Follow-up out-patient appointments will be booked by one of two processes, depending on the time frame in which the appointment is required:
Patients who attend an Outpatient clinic and as a result require a further follow up appointment within 6 weeks will be given a Clinical Outcome Form by the Clinician
indicating the time frame for follow up and the appointment will be made in real time at the reception desk.
Patients who attend an Outpatient clinic and as a result require a further follow up appointment more than 6 weeks in the future will be added to a Review List (as indicated on the Clinical Outcome Form) and their follow-up appointment will be made by staff in the Patient Contact Centre four weeks before the required follow-up appointment.
7
Diagnostics
Patients requiring a diagnostic test or procedure will be booked in accordance with the following pathways:
7.1 GP Direct Access to diagnostics (not part of RTT pathway)
The source of these referrals is external to the Trust. They do not form part of an RTT pathway as there is no clock start. The results from the diagnostic go back to the referring GP whose care the patient remains under.
7.1.1 Direct Access Radiology Diagnostics Pathway
All requests must be correctly date stamped on the day of receipt within the Trust and scanned onto the Radiology System. All vetting of requests should be carried out within two working days of being received within the Trust. The patient will be allocated an appointment within six weeks of receipt of referral.
All appointment letters should be sent within two days of the referral being vetted. If a patient is unable to accept an appointment which is within a reasonable offer period of two weeks, another appointment should be offered for as soon as possible within six weeks. Any appointment made by telephone conversation with the patient is considered a “negotiated appointment” and is binding.
Some Patients on a Radiology direct access to diagnostic pathway will be offered a ‘walk in service’ for plain film X-Rays only. Patients will attend the Radiology Department within specific timeframes for their diagnostic test as set out in their appointment letter.
7.1.2 Patient Failure to Attend Appointments
If a patient DNA’s the appointment or cancels on the day, the request will be removed and referred back to the GP. The GP will be required to make a “new” request if the examination is still required.
7.1.3 Patient Cancellation of Appointment
If a patient contacts the Trust within 7days of receipt of appointment letter to change their appointment, a new appointment will be arranged within their 6 week wait target time. If a patient contacts the Trust more than 7 days after receipt of receiving their appointment letter, a new appointment will be arranged within a newly calculated 6 week target time. The start of this 6 week wait will be from the date the patient contacts the hospital to re-arrange their appointment.
If a patient contacts the Trust to change their appointment less than 48 hours before their booked appointment, a new appointment will be arranged within a re-calculated 6 week wait target time. The start time of this 6 week wait will be from the date of the cancelled appointment.
If the appointment date is cancelled for a second time then the referral must be discharged back to their GP.
7.1.4 Hospital Cancellation of Appointment
Hospital cancellations must be kept to an absolute minimum. When they do occur, the patient must be contacted by phone and should be offered a new appointment date within the six week diagnostic wait period.
7.1.5 Last Menstrual Period (LMP) Patients
The request card should be received & stamped as normal. The event should be marked as ‘Awaiting Clinical Information’. When the patient telephones with their date of LMP the day 1 of their LMP should be used for the ‘Wait Start Date’. The card should be re-stamped, noted and re-scanned onto the Radiology system.
7.2 Consultant led Diagnostics
These referrals are requested by Consultants to assess the patient with a view to confirming diagnosis and providing treatment where appropriate. All patients awaiting unplanned diagnostics should be presumed to be active on their RTT Pathway.
7.2.1 Timeframes for Consultant Led Diagnostics
The diagnostic Wait Start Date is the date that a valid referral was made by the referring clinician within the Trust not the date that the department received the request.
7.2.2 Patient Unavailability
If a patient is unable to accept a 2 week reasonable offer, another appointment should be offered for as soon as possible within the 6 weeks diagnostic target. If this appointment is not accepted then the referral should be returned to the referrer. Where a clinical decision is made to either discharge the patient or place the patient on ‘active monitoring’, this will ‘stop’ their RTT clock. If this appointment is accepted then the new Diagnostic Start Date should be set to the first offered appointment date.
Suspensions are not permitted in the 6 weeks diagnostic pathway. The end of diagnostic wait is when the patient receives the diagnostic test/procedure. A diagnostic procedure does not stop the RTT clock.
If a patient requires inpatient or day case admission for a diagnostic procedure as part of an RTT pathway, the diagnostic procedure is still required to be completed within a 6 week pathway.
7.2.3 Patient Failure to Attend Appointments
If a patient DNAs or cancels on the day of their appointment then their 18 week clock will be stopped. A new clock start will be applied when the patient accepts a further offer of diagnostic date. If a patient DNA’s for the second time. The examination will be cancelled and the referral sent back to the referrer, unless the patient is on an active Target pathway.
7.2.4 Patient Cancellation of Appointments
A negotiated appointment which is subsequently cancelled by the patient is counted as a self-deferral and the Diagnostic Wait Start Date is set to the self deferral date. The patient must then be offered another appointment as soon as necessary to prevent the patient breaching the recalculated 6 week diagnostic waiting time.
If the patient requests to wait longer than this they must be discharged back to their referring Consultant.
If a patient is unable to agree a new appointment or if a patient cancels a rescheduled appointment (i.e. a 2nd cancellation) they will be discharged back to the care of their referring clinician and the GP informed. This will stop the RTT clock.
7.2.5 Hospital Cancellation of Appointments
Hospital cancellations must be kept to an absolute minimum. When they do occur, the patient must be contacted by phone and should be offered a new appointment date within the six week waiting time.
7.3 Endoscopy Referrals
All Endoscopy referrals should be added to appropriate waiting lists within 2 working days of receipt of referrals, and should be booked and their procedures carried out within 6 weeks if a diagnostic referral or within 2 weeks if a CWT referral.
Referrals for surveillance diagnostics should be held on planned waiting lists where appropriate and dated as clinically indicated.
7.4 Direct Access Audiology (Direct Access RTT week pathway – non medical/surgical consultant led)
The source of these referrals is external to the Trust. The start of the direct access clock is when the request is received by Audiology Department.
7.4.1 Timeframes for Audiology Appointments
The Diagnostic assessment of the patient should take place within 6 weeks of the receipt of the referral. All patients will be offered Audiology appointments within the Audiology Direct Access RTT week Pathway.
The Audiology Department will be responsible for in first instance calling the patient to offer an appointment date, if this is not possible the department will then send a letter to the patient with an appointment date giving a minimum of 2 weeks notice of the appointment.
7.4.2 Patient Unavailability
Where Patient’s refuse a reasonably offered appointment, with at least 2 weeks notice, and they are not able to accept another appointment within 1 week of the initially offered appointment, they will be discharged and returned to their referrer.
7.4.3 Patient Failure to Attend Appointments
If a patient DNA’s their first Audiology appointment they will be discharged back to their referrer and the clock nullified, provided that the provider can demonstrate that the appointment was clearly communicated to the patient.
Patients with a New Audiology appointment who contact the Audiology Department on the day of their appointment to say they are unable to attend will be offered another appointment the within 1 week. If they are unable to accept this offer of a new appointment they will be discharged back to their referrer.
If a patient has DNA’d an appointment then staff need to establish if the patient is still active on the RTT week pathway. If they are they should contact the patient by phone on the day they have DNA’d and offer them an appointment the following week. If the patient will not agree to this then they will be discharged back to their referrer.
If a patient is still active on the RTT pathway and DNA’s an appointment on 2 occasions they will be discharged back to their referrer.
A patient can be discharged back to the referrer provided that:
a) the provider can demonstrate that the appointment was clearly communicated to the patient
b) discharging the patient is not contrary to their best clinical interests
c) Discharging the patient is carried out according to local, publicly available, policies on DNAs.
d) These local policies are clearly defined and specifically protect the clinical interests of vulnerable patients and are agreed with clinicians, commissioners, patients and other relevant stakeholders.
7.4.4 Patient Cancellation of Appointments
A negotiated appointment which is subsequently cancelled by the patient is counted as a self-deferral and the 6 week diagnostic wait start date is set to the old appointment date. If a patient cancels a previously agreed Audiology appointment for a social reason or ill health they must be offered another appointment as soon as necessary to prevent the patient breaching the 6 week assessment waiting time. If a patient with an agreed appointment contacts the hospital to cancel the appointment they must agree a new appointment within 2 weeks of the appointment they wish to change. If the patient requests to wait longer than this they must be discharged back to their referrer.
If a patient is unable to agree a new appointment or if a patient cancels a rescheduled appointment (i.e. a 2nd cancellation) they will be discharged back to the care of their referrer and the referrer informed.
7.4.5 Hospital Cancellation of Appointments
Hospital cancellations must be kept to an absolute minimum. When they do occur, the patient must be contacted by phone and should be offered a new appointment date within 5 working days.
Staff must check the patients waiting time for their diagnostic procedure and must ensure that the patient does not breach the 6 week waiting time.
7.5 Consultant Led Audiology Diagnostics (Patients who are on an 18 week RTT pathway)
8
Inpatient Waiting List Management
8.1 Adding Patients to a Waiting List National Standard:
As of 1st April 2010 All patients are entitled to have their treatment within timescales identified in section Referral to Treatment Pathway above
Local Standard:
All Patients should be added to the PAS Waiting List within 2 working days of the Decision to Add being made – Exceptions for TOLCE Procedures
Key Data Input:
The Original Date on List is always the date the decision is taken to add the Patient to the Waiting list. If the Patient has been transferred from another provider, the original date on list still applies. This date must not be changed.
The decision to add a patient to a Waiting List must be made by a Consultant or under an arrangement agreed with the Consultant and must be prioritised as Urgent or Routine. The patient must have agreed to the proposed treatment and have agreed to be placed on a Waiting List. The patient must be clinically and socially ready for admission on the day the decision to admit is made.
Patients who are not fit, ready and able to come in on the date the decision to admit is made, or where there is no serious intention to admit them must not be added to the Waiting list and should be referred back the care of their GP in order to be re-referred when fit or reviewed again in Outpatients.
Patients who decide to wait longer than 10 Weeks for a procedure for social reason will be removed from the Wait List and returned back to the care of their GP. Their RTT clock will be stopped.
National Standard:
Clinical Priority should be defined as Urgent or Routine only.
The Sub-Specialist nature of the Waiting List addition must also be recorded. (Ref:DSCN34/2003)
8.2 Treatments of Limited Clinical Effectiveness (TOLCE)
Exceptions to the guidance above are for patients that are listed for a procedure of Limited Clinical Effectiveness. Information in this section is set out by the PCT as a mandatory requirement. The guidance includes the following information:
8.2.1 The TOLCE process stipulates a number of procedures within a range of Specialties that will need a funding approval from the PCT before the patient can be added to the waiting list and the procedure can go ahead.
8.2.2 When a treatment decision is made that a patient requires a TOLCE procedure, the Clinician is then responsible for ensuring the patient meets the criteria set by the PCT for the procedure. Patients that do not meet the criteria will agree a further treatment plan with the clinician. Patients that do meet the criteria will have their wait list card along with details of how the patient meets the criteria of the procedure sent to the PCT for funding approval.
8.2.3 The PCT stipulate a TOLCE procedure decision deadline of 28 days. If the patients funding is declined, the patient will receive a letter from the PCT detailing reasons for the decline with the option to appeal against this decision if they wish. This will stop the RTT clock. Any patient appeals that result in a successful outcome will be added straight to the waiting list from the date of the appeal outcome decision. This will restart the RTT clock on the date the patient was added back on to the waiting list.
8.2.4 If the patients funding is approved, the patient will be added to the wait list from the date the decision was made to list and will follow the same guidance as set out below. 8.2.5 Exceptions to this process are for all Urgent and Cancer wait target patients. Patients listed for a TOLCE procedure under the category of Urgent or Cancer will not be required to go through this process.
8.3 Offering To Come In (TCI) Dates National Standard:
For a written appointment offer to be deemed reasonable, the Patient will be offered an appointment with a minimum of three weeks notice.
For a verbal appointment offer to be deemed reasonable, the Patient will be offered a choice of two appointment dates with a minimum of three weeks notice to the first date.
This section sets out the responsibilities of Booking Officers when offering To Come In Dates (TCI’s) to patients.
8.3.1 Short notice offers of TCI’s
Patients should be offered dates strictly in turn within their Clinical priority.
Patients should be given the opportunity to agree a date for treatment that is convenient for them but within the current maximum waiting times. At all times the Guidance for
