Joint Patient Access Policy

JOINT PATIENT ACCESS POLICY

Version / 8.1
Name of responsible (ratifying) committee / Operational Board
Date ratified / 21 December 2016
Document Manager (job title) / Head of Performance
Date issued / 12 January 2017
Review date / 11 January 2018
Electronic location / Information Services website, Management Policies
Related Procedural Documents / -
Key Words (to aid with searching) / RTT, Access, 18 weeks

Version Tracking

Version / Date Ratified / Brief Summary of Changes / Author
8.1 / - / Flow diagrams updated re: PAS Version 5 / J Lowe
8 / 21/12/2016 / Reflects changes to national RTT rules and DNA and patient cancellation management / J Lowe
7 / 19.08.2015 / Reflects changes to national RTT rules / J Lowe
6 / 21/01/2015 / Simplified and minor changes / Jane Lowe
5 / 20/11/2013 / Change to management of planned patients not treated by clinically determined date / Jane Lowe
Content / Page/s
Introduction / 5
Purpose / 5
Scope / 5
Definitions / 6
Duties and Responsibilities / 9
Key Principles / 12
Private Patients transferring to NHS care / 15
Process / 16
Unwarranted and Incomplete Referrals / 16
New patient referrals via NHS eReferral / 16
New patient paper Referrals / 18
Consultant to Consultant referrals / 19
Referrals from Interface, Referral Management or Assessment/Triage services / 19
Reasonable Offers / 19
Unable to Contact Patient / 20
Outpatient Clock Pause / 20
Patient Cancellations / 20
Patients who arrive late for appointments / 21
Hospital cancellations / 21
Did Not Attend (DNA) / 21, 22
Follow-up appointments / 22
Planned follow-up appointments / 23
Active Monitoring / 23
TCI (To Come In) forms / 23
Clinic outcome forms / 24
Inter-provider and Interface service referrals / 24
Management of Transplant Patients / 24
Management of living donors / 25
Elective inpatient and day cases / 25
Clock stops for treatment / 25
Patient priority / 25
Planned patients / 26
Patient initiated delays / 27
Patient unavailable when decision to treat is made / 28
Clinically initiated delays / 28
Bilateral procedures / 28
Pre-operative assessment / 28
Adding patients to the waiting list / 29
Prior approval/funding request/procedures not normally funded / 29
Selecting patients from the inpatient waiting list / 30
Hospital initiated cancellations / 30
New/subsequent 18 week clock starts / 31
Access to healthcare for Military veterans, personnel and their families / 31
Cancer Patients / 32
Training and Validation / 36
References and Documentation / 37
Appendix 1- Basic Rules (Quick Guide) / 38
Appendix 2- Generic Cancer Pathway Standards / 39
Appendix 3- Frequently Asked Questions (FAQs) and tips / 40,41
Appendix 4- Primary Care Referral Process / 42
Appendix 5- Inter-Provider / Tertiary Referral Process / 43
Appendix 6 – 2WW Referral Process / 44
Appendix 7- Consultant to Consultant Referral Process / 45
Appendix 8- New patient appointment process / 46
Appendix 9- Follow-up patient appointment process / 47
Appendix 10-Cancellation on the day and DNA process / 48
Appendix 11-TCI Process- adding to a waiting list / 49
Appendix 12- TCI Process- following a procedure / 50
Appendix 13- Individual Funding Requests (prior approval) / 52,53
Appendix 14 - Restricted and excluded Procedures / 54
Monitoring Compliance / 55

QUICK REFERENCE GUIDE

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

Introduction

Purpose

Scope

Definitions

Duties and responsibilities

Monitoring Responsibilities

Key Principles

Process

Training Requirements

Monitoring compliance and effectiveness

References

Equality Impact Statement

1. INTRODUCTION

Portsmouth Hospitals NHS Trust (PHT) is committed to ensuring that patients receive treatment in accordance with the NHS Constitution, Armed Forces Covenant,national objectives and targets.

This policy sets out the Trusts Local Access Policy and takes into account guidance from the NHS England and has been agreed with local commissioners. This policy is intended to support a maximum wait of 18 weeks from referral to first definitive treatment, and is designed to ensure fair and equitable access to hospital services.

The overall aim of the policy is to ensure patients are treated in a timely and effective manner, specifically to:

Ensure patients receive treatment according to their clinical priority, with routine patients and those with the same clinical priority treated in chronological order, thereby minimising the time a patient spends on the waiting list and improving the quality of the patient experience.
Ensure military personnel and their families receive equitable access to timely treatment and are not disadvantaged, taking into account time already spent on an NHS waiting list when transferring to the Trust for treatment.
Reduce waiting times for treatment and ensure patients are treated in accordance with agreed targets.
Reduce the number of cancelled operations for non-clinical reasons
Allow patients to maximize their right to patient choice in the care and treatment they need.
Increase the number of patients with a booked outpatient or in-patient / day case appointment, thereby minimising Did Not Attends (DNAs), cancellations, and improving the patient experience.

This policy should be used in conjunction with the policy for Management of Overseas Visitors, Policy on Procedures of Low Clinical Value, Cancer Access Policy and the Outpatient Guide. A summary version of this document is also available for patients.

2.PURPOSE

The purpose of this policy is both a statement for the management of patients on an 18 week Referral To Treatment (RTT) pathway and an operational guide for those staff involved in the management of these pathways. It sets out the roles and responsibilities, processes to be followed and establishes a number of good practice guidelines to assist staff with the effective management of patients who need to come into hospital for treatment as an outpatient, in-patient, day case or a diagnostic test.

3.SCOPE

This policy applies to all PHT staff involved in the management of waiting lists.

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

4.DEFINITIONS

The following is a list of the definitions issued by the Department of Health that are used in this Policy:

18 week Referral to TreatmentThe part of the patient’s care following

(RTT) periodinitial referral which initiates a clock start,

Leading up to the start of the first definitive treatment or other 18 week clock stop point

Active monitoringWhere it is clinically decided to start a period of monitoring in secondary care without clinical intervention or diagnostic procedure at that stage.

Active waiting list The list of elective patients who are fit and

able to be treated at that point in time. The active waiting list is also used to report national waiting time statistics.

Advice & Guidance (A&G)This is a functionality within eReferral which allows one clinician to seek advice from another.

Cancelled operations / proceduresIf the Trust cancels a patient’s operation or procedure on the day of, or after admission for non-clinical reasons – the Trust is required to rearrange treatment within 28 days of the cancelled date or within target wait time whichever is soonest.

Chronological order (in turn)The general principle that applies to patients categorized as requiring routine treatment. All routine patients should be seen or treated in the order they were initially referred for treatment.

Converts their UBRNWhen an appointment has been booked or an attempt made to book through NHS eReferral, the UBRN (Unique Booking Reference Number) is converted.

Clinical TriageClinical assessment of referrals (excluding 2 week waits) to determine the urgency (urgent or routine) and most appropriate clinic. This should also include rejection of incomplete and unwarranted referrals.

CSCClinical Service Centre

CWTCancer Waiting Times

Decision To Admit (DTA)Where a clinical decision is made to admit the patient for either day case or inpatient treatment.

Decision To Treat (DTT)Where a clinical decision is taken to treat a patient as an inpatient, day case or outpatient setting.

Defer to ProviderWhere no appointments are available via NHS eReferral, but the patient wishes to be seen by the Trust

Did Not Attend (DNA)Patients who have agreed or been given reasonable notice of their appointment / treatment and who without notifying the Trust fail to attend.

Elective admission / electiveInpatients are classified in two groups,

patientsemergency and elective. Elective patients are so called because the Trust can ‘elect’ when to treat them.

Elective PlannedPatients admitted, having been given a date or approximate date at the time that the decision to admit was made. This is usually part of a planned sequence of clinical care determined mainly on clinical criteria.

Elective waitingPatients waiting elective admission

EROD Earliest Reasonable Offer Date

First definitive treatmentAn intervention intended to manage a patients disease, condition or injury and avoid further intervention. What constitutes first definitive treatment is a matter of clinical judgment in consultation with others as appropriate, including the patient.

Incomplete pathwaysPatients either on an admitted, non-admitted or diagnostic pathway still awaitingtreatment or other clock close.

InfoflexSystem for recording of cancer pathways and clinical interventions

NHS eReferral ServiceNHS eReferral is a national electronic referral service that gives patients a choice of place, date and time for their first consultant outpatient appointment

OutpatientsPatients referred by a general practitioner (medical or dental) or another consultant / health professional for clinical advice or treatment.

OWLOutpatient Waiting List. PAS module for the monitoring and management of patients who require planned follow-up in outpatients within a clinically defined time frame.

PASPatient Administration System. The Trusts computer system used to record patient demographics and detail all patient contact with the hospital.

PTLPrimary Targeted List. A report used to ensure the maximum waiting time targets are achieved by identifying all patients that will breach current wait time targets.

RTTReferral to Treatment. From December 2008 the maximum waiting time for NHS patients is 18 weeks from referral to treatment. This policy has been updated to include the June 2015 guidance ‘Making waiting times work for patients’

TCI (To Come In)A proposed future date for elective admission

UBRNUnique Booking Reference Number used for NHS eReferral service. The patient is notified of this on their appointment request letter when generated by the referrer through NHS eReferral. The UBRN is used in conjunction with the patient password to make or change an appointment.

5.DUTIES AND RESPONSIBILITIES

Chief Executive

The Chief Executive is ultimately accountable to the Trust Board for ensuring that effective processes are in place to manage patient care and treatment that meet national, local and NHS Constitution targets and standards and for achieving these targets.

Chief Operating Officer and Director of Scheduled Care

The Chief Operating Officer is the executive lead for clinical operations and the Director of Scheduled Care has delegated authority and both are responsible for:

Ensuring that effective processes are in place to manage patient care and treatment that meet national, local and NHS Constitution targets and standards, through Clinical Service Centre (CSC) General Managers and Chiefs of Service.
Achieving access targets, including Referral to Treatment times, NHS eReferral and cancelled operations, with General Managers and Chiefs of Service.
Implementing Trust wide monitoring systems to ensure compliance with this policy and avoid breaches of the targets.
Monitoring progress against achievement of the targets and taking action to avoid any potential breaches, with General Managers and Chiefs of Service.
Managing any actual breaches in achieving targets with General Managers and Chiefs of Service.
Keeping the Trust Board and Senior Management Team informed of progress in meeting access target and any remedial action taken.
Delivering operational targets for service delivery in line with the annual business plan to include national targets – including 18 weeks, cancer waiting times and all other key access targets.
Conducting a capacity and demand review Trust wide.
The management, communication and dissemination of the Trust Access Policy.
Ensuring that principles of managing demand, activity, capacity and variation are embedded in service development and part of the business cases for investment and development of services.

CSC General Managers and Chiefs of Service

The General Managers and Chiefs of Service for each CSC have overall responsibility for implementing and adherence to this policy within their CSC. This includes:

Ensuring that effective processes are in place to manage patient care and treatment that meet national, local and NHS Constitution targets and standards for each specialty within the CSC.
Managing resources allocated to the CSC with the aim of achieving access targets. This includes having the staff and other resources available to operate scheduled outpatient clinics, patient treatment and operating theatre sessions and avoid the need to cancel patient treatment.
Working with other CSC General Managers and Chiefs of Service to provide a joined-up approach to implementing this policy and achieving access targets, particularly around outpatient and operating theatre capacity and availability of diagnostic services.
Achieving access targets, including Referral to Treatment times, NHS eReferral and cancelled operations.
Ensuring that the duties, responsibilities and processes laid down in this policy are implemented within the CSC.
Ensuring all business unit staff that needs to operate this policy are both aware of and receive training as detailed in this policy.
Implementing effective monitoring systems with the CSC to ensure compliance with this policy and avoid breaches of the targets: escalate any actual or potential breaches to the Chief Operating Officer.
Implementing systems and processes that support data quality and for validating data to ensure that all reports are accurate and produced within agreed timescales.

Day to day operational management of this policy will be delegated to CSC Business and Service Managers as set out in the governance arrangements for each CSC.

Consultants

Each consultant is responsible for:

Reviewing all patient referrals, allocating a clinical priority and forwarding the referral to the responsible booking team within two working days of their receipt at the Trust. All referrals judged either incomplete or unnecessary (as outlined in Section 8.1) should be returned to the originating referrer with a brief clinical explanation within three working days. All Advice and Guidance requests on NHS eReferral should be responded to by the requested consultant or designated deputy within three working days (see Section 8.3). Compliance with this will be monitored.
Reviewing all referrals made using the NHS eReferral system within a three working day period. If, however, the provider clinician delegates any of these tasks, even if this is within a standard protocol, they need to be satisfied that those whom they delegate are competent, appropriately qualified, experienced and are provided with sufficient information to undertake the task delegated to them. The clinician will still be responsible for the overall management of the patient, and accountable for the decision made by the delegate. Any referrals which are not reviewed within this agreed timeframe will be automatically accepted by the Trust and the clinician will be expected to see the patient as booked. Any referrals returned to the originating referrer must be completed within this timeframe.
Managing the patients care and treatment and working with their CSC General Managers and Chiefs of Service and clinical colleagues to ensure that this is provided within timescales laid down in national, local and NHS Constitution targets and standards.
Alerting the CSC General Manager of any potential or actual breaches of targets.
Managing medical staff to ensure that scheduled outpatient clinics, patient treatment and operating theatre sessions are held and avoid the need to cancel patients.
Managing waiting lists and deciding on patient admissions / treatments in line with clinical priority and order of inclusion on the waiting list.
Working with colleagues to prevent the cancellation of patient admissions for non-clinical reasons and taking action to reschedule any patients so cancelled in line with timescales set out in this policy.
Ensuring the safety of patients waiting for treatment, particularly if treatment is delayed this may include clinical review and providing guidance to booking staff to support management of patients who cancel or DNA their appointments.
Communicating accurate waiting time information to patients, their families and carers and dealing with any queries, problems or complaints in line with Trust policy.
Assisting with the monitoring of waiting lists, data quality and production of reports.

Outpatient Booking Centre staff and those staff designated to make outpatient appointments including for diagnostic tests and treatment are:

To receive outpatient referrals and ensure that they are date stamped, and enter details on to the Trusts Patient Administration System (PAS) within 24 hours.
To refer them to the appropriate consultant to assign clinical priority.
Once clinical priority has been assigned, to contact the patient, to agree an outpatient appointment, with reasonable notice (21 days) and a choice of appointment date as laid out in this policy.
To ensure all outpatient appointment offers are recorded on PAS.
To ensure cancellation reasons are recorded on PAS.
To ensure PAS is updated correctly and in a timely way e.g. within 2 working days with any patient choice decisions.
To ensure the appropriate Referral to Treatment (RTT) status is accurately recorded on PAS.
To refer any problems or suspected / potential breaches of policy or compliance with RTT targets to the appropriate service or Business Manager / General Manager.

Access Managers (with their staff) are:

To maintain an up to date and accurate waiting list.
To add patients to the waiting list within 2 working days of a decision to admit.
To ensure when a decision to admit is made in clinic, the clinic attendance date matches the date added to waiting list when recording on PAS.
To ensure all patient contact details with any additional information required is correctly recorded on PAS.
To ensure patients are given reasonable notice as per national guidance and a choice relating to appointment and admission dates as outlined in this policy.
To ensure that all admission offers are recorded on PAS.
To ensure that any patient initiated pauses are recorded on PAS – note that a pathway cannot be paused until the patient has been offered reasonable notice.
To record all reasons for pauses and cancellations on PAS.
To validate pathways and verify the wait as patients are added to the admitted pathway and to ensure that validation routines are carried out regularly.
To ensure the appropriate RTT status is accurately recorded on PAS.

Head of Information and Communications Technology (ICT) Shared Services is responsible for:

The management of the hospitals computerised information systems and IT training team.
Providing IT training for all staff required to operate this policy.

Head of Information Services is responsible for:

Ensuring the operational management teams and Access Managers have accurate timely reports that enable them to manage their patients according to this policy.
Providing reporting that enables teams to proactively manage patients and avoid breaches.
Quality assuring and producing accurate performance management data for use by Trust managers and for reporting data to external sources.
Ensuring reporting reflects national best practice.

Head of Performance is responsible for:

Supporting CSC General Managers in the delivery of the access targets
Reviewing performance and providing early warning of potential adverse variance to delivery.
Working with CSC General Managers to develop remedial action plans if required.
Ensuring the Trust Access Policy is up to date and reflective of best practice national guidance.
Developing auditing and spot checks to ensure compliance with this policy and best practice.
Providing advice and guidance on the implementation and delivery of this policy.

General Medical / Dental Practitioners and other referrers

The Trust relies on GP’s and other referrers, supported by local commissioners to ensure patientsunderstand their responsibilities and potential pathway steps and timescales when being referred. This will help ensure patients are: