NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST

PATIENT ACCESS MANAGEMENT POLICY

Documentation Control
Reference / CL/CGP/026
Approving Body / Directors’ Group
Date Approved
Implementation Date
Version / 5
Summary of Changes from Previous Version / Merged into one document for easy reference with production of procedural guidance for end users.
Substantive changes:
- Number of weeks that a patient can choose to wait for treatment. Currently at 12 months proposed change in line with the majority of Trusts nationally to 2 months.
Supersedes / NUH Version 4 November 2010
Consultation Undertaken / Patient Access Management Group – April 2013
Patient Partnership Group – May 2013
Commissioners – May 2013
Directors Group – May 2013
Date of Completion of Equality Impact Assessment / 28 February 2013 – see separate template attached at Appendix 1
Date of Completion of We Are Here for You Assessment / 28 February 2013 – see separate template attached at Appendix 3
Date of Environmental Impact Assessment (if applicable) / 28 February 2013 – see separate template attached at Appendix 2
Legal and/or Accreditation Implications / Support the delivery of standards within the NHS Standard Contract for Acute Services and the NHS Operating Framework (Everyone Counts – Planning for Patients)
Target Audience / Referrers, Patients, Commissioners and NUH Staff
Review Date / May 2014
Lead Executive / Director of Operations
Author/Lead Manager / Rachel Eddie, Deputy Director of Operations
Ext 76036
Further Guidance/Information / Annette Gunn, Corporate Operations Manager
Ext 59672

CONTENTS

Paragraph / Title / Page
1. / Introduction / 4
2. / Executive Summary / 4
3. / Policy Statement / 4
4. / Definitions (including Glossary as needed) / 5
5. / Roles and Responsibilities / 6
6. / Policy and/or Procedural Requirements
6.1 Referrals
6.2 Outpatient Appointments
6.3 Outpatient Cancellations and DNAs
6.4 Diagnostics
6.5 Inpatients and Day Cases
6.6 Inpatient Cancellations and DNAs
6.7 Patient Initiated Delays
6.8 Clinical Delays
6.9 Safeguarding Children and Young People and Vulnerable Adults
6.10 Private Patients
6.11 Overseas Patients
6.12War Veterans / 7
9
10
11
11
13
14
15
15
15
16
17
7. / Training, Implementation and Resources / 17
8. / Impact Assessments / 18
9. / Monitoring Matrix / 19
10. / Relevant Legislation, National Guidance and Associated NUH Documents / 20
Appendix 1 / Equality Impact Assessment / 21
Appendix 2 / Environmental Impact Assessment / 24
Appendix 3 / Here For You Assessment / 26
Appendix 4 / Certification Of Employee Awareness / 28
1.0 / Introduction
1.1 / Nottingham University Hospitals NHS Trust (NUH) aims to offer patients timely and equitable access to elective services in line with national standards to support the delivery of high quality, effective and efficient patient care and the achievement of the Trusts’ core business objectives and statutory obligations.
2.0 / Executive Summary
2.1 / This policy sets out the way in which NUH will approach the management of its elective Outpatient, Diagnostics and Inpatient waiting lists. It is supported by a reference guide (Patient Access Policy Procedural Guidelines) for all staff involved with waiting list management and sets out the mandatory minimum requirements to be adopted by all specialties.
The overall purpose of this Policy is to establish a consistent approach to the management of patient waiting lists and times within the Trust.
3.0 / Policy Statement
3.1 / The principles of the Policy are as follows:
  • We will offer patients timely, equitable and transparent access to elective care;
  • We will offer patients appointments and admission dates in order of clinical priority and their waiting time guarantee date (RTT or other National or locally agreed target), allowing for the need to use resources effectively;
  • We will communicate effectively with patients and GPs at all stages in a patients pathway;
  • We will offer patients reasonable notice of appointment and admission dates;
  • We recognise the distress caused to patients when appointments or admissions are cancelled or rescheduled and we will put processes in place to ensure that this is avoided wherever possible;
  • We will accurately record all patient details and pathways on Trust systems in a timely manner to support effective management of pathways;
  • We will ensure that all staff involved in the provision or administration of elective care are aware of their responsibilities within the Policy and are appropriately trained;
  • We will ensure that children and vulnerable adults are not disadvantaged by application of the Policy. Patients with a health condition that affects communication with them, such as dementia, learning disability, or deafness will be clearly identified wherever possible and their pathways management appropriately.
Patient safety is our first priority. The Policy is not intended to override clinical judgement and all staff are expected to make decisions in the best interests of patients at all times within the context of the Policy and the best use of Trust resources.
4.0 / Definitions
4.1 / Choose and Book (C&B) - A national electronic referral service that gives patients a choice of place, date and time for their first out-patient appointments.
Clock – refers to the Referral to Treatment (RTT) clock which measures the time the patient has been waiting from referral.
Did Not Attend//Did Not Bring (DNA/DNB) - Patients who have been informed of their date of appointment, admission or pre-assessment and who without notifying the hospital did not attend. Did Not Bring applies to paediatric patients.
Directory of Services (DOS) - The Directory of Service is an element of the Choose & Book system which information at service level that describes the services the Trust offers.
Elective – refers to any planned hospital attendance/treatment.
GP – General Practitioner (in this document is used to indicate any referrer to secondary care – e.g. dentists, optometrists)
Guarantee Date – date by which the patients diagnostic or treatment must be undertaken in line with relevant national waiting time
Partial Booking – the process whereby a patient is held on a waiting list and offered a choice of appointment/admission dates at an appropriate time.
Pathway – a succession of episodes of care from referral to treatment and beyond which relate to one condition.
Patient Administration System (PAS) - Patient Administration System: computerised hospital record keeping system.
Planned Waiting List – a list of patients who are undergoing review or surveillance procedures at regular intervals or require a procedure when certain clinical criteria are met.
Referral To Treatment (RTT) - The part of the patient’s care following initial referral, which initiates a clock start, leading up to the start of first definitive treatment or other 18 week clock stop points.
5.0 / Roles and Responsibilities
5.1 / Committees
5.1.1 The Patient Access Management Group (PAMG) is responsible for the implementation of the policy and for ensuring that processes are in place at specialty level to monitor and manage adherence to the Policy. The Group will review the Policy at regular intervals to ensure that it reflects local and national guidance.
5.1.2 Directors Group (DG) is responsible for ratifying revision to the Policy.
5.2 / Individual Officers
5.2.1 The Chief Executive is ultimately accountable for the delivery of the national access targets.
5.2.2 The Director of Operations has delegated responsibility for ensuring that robust systems and processes are in place to support the achievement of the access targets and that there is accurate reporting both internally and externally.
5.2.3 The Director of Health Informatics / Deputy Director of Information have responsibility for ensuring that there are effective systems in place to enable the Directorates to collect data accurately and to support the accurate monitoring and reporting of waiting lists and performance against access targets;
5.2.4 Directorate Clinical Directors and General Managers are responsible for ensuring that waiting lists are managed appropriately within their directorate. It is the responsibility of Directorates to ensure that their patients are managed in accordance with this policy and the procedural guidelines which underpin it.
5.2.5 The clinical management of individual patients on the waiting lists is the responsibility of the Clinician in charge of the patients care.
6.0 / Policy and/or Procedural Requirements
6.1 / Referrals
6.1.1 Wherever possible, referrals should be booked using the National Choose and Book service.
6.1.2 Each service should have an up to date Directory of Service within Choose and Book which is reviewed on an annual basis in conjunction with the lead clinician for that service. This will support GPs in referring patients into the appropriate services.
6.1.3 Each service should offer access to Advice and Guidance to referrers via Choose and Book and ensure that arrangements are in place to meet agreed turnaround times.
6.1.4 Paper referrals will be accepted and processes will be in place to ensure that appointment offers are equitable with those made via Choose and Book.
6.1.5 Inappropriate referrals, including those which do not meet agreed referral criteria, will be rejected and returned to the referrer with an explanation, or forwarded on to the appropriate department.
6.1.6 Referrals to and from other organisations will be managed via the Inter-Provider Transfer process which ensure that all necessary data is transferred and that the patients RTT pathway transfers with them.
6.1.7 The need to vet referrals will be locally determined by the specialty and will depend upon the level of urgent and/or inappropriate referrals.
6.1.8 Consultant annual leave, study leave or sickness should not delay the review of referrals thereby disadvantaging patients. A nominee must be able to review and prioritise in the Consultant’s absence.
6.1.9 The Consultant or nominee will decide if a referral is appropriate. The Consultant can upgrade a routine referral to urgent or suspected cancer, but cannot downgrade an urgent suspected cancer referral unless it is agreed with the referring GP.
6.1.10 An agreed protocol is in place between NUH and Commissioners which allows Consultant to Consultant referrals only in certain circumstances. If the exclusion criteria in the protocol do not apply, the patient should be referred back to the GP who will make a new referral at the patient’s choice of provider.
6.2 / Outpatient Appointments
6.2.1 All appointment offers will be ‘reasonable’.
6.2.2 Appointments booked via Choose and Book will automatically be deemed “reasonable” due to patient choice.
6.2.3 Patients referred by letter will be offered a maximum of two dates with at least two week’s notice.
6.2.4 All patients referred for suspected cancer will be offered an appointment within 14 days of referral.
6.2.5 For non Choose and Book appointments, the hospital operates a system of partial booking which improves patient choice, reduces DNAs and thereby uses resources more effectively. Patients are contacted via letter to invite them to make an appointment. If the patient does not respond within one week of receipt of the letter, the patient is discharged back to the care of their GP (with the exception of suspected cancer patients who would be contacted by telephone).
6.2.6 Patients will be provided with a follow up appointment based on clinical need only.
6.2.7 Hospital attendances should be avoided where patients can be offered a non-face-to-face consultation, for example, for confirmation of test results.
6.2.8 Patients requiring long term follow up may be held on review lists until nearer their appointment due date and will then be offered a date through the partial booking process. If a date has not been agreed with the patient by the time of the follow up due date, then a new RTT pathway will be started.
6.2.9 Where appropriate to the service, open appointments can be offered for a maximum of three months for adults and twelve months for children.
6.2.10 If a patient is likely to require a diagnostic test during an appointment, every effort will be made to offer the appointment and the diagnostic test on the same day.
6.3 / Outpatient Cancellations and DNAs
6.3.1 The patient’s responsibility to keep an agreed appointment and outcomes if not kept will be clearly detailed in the appointment letter. NUH commits to make reasonable offers of appointments and to allowing patient to reschedule appointments within reason where notice is given.
6.3.2 A patient who cancels their first outpatient or follow up appointment will be offered a further appointment up to a maximum of two months. If the patient cancels a second outpatient appointment, with the exception of suspected cancer patients, they will be referred back to the care of their GP.
6.3.3 A patient who DNAs a new appointment will be referred back to their GP, with the exceptions of suspected cancer patients. A further appointment will only be given if the consultant deems it essential or if the patients’ GP contacts the department.
6.3.4 A patient who DNAs a follow up appointment will be referred back to the care of their GP unless the clinician reviewing the notes specifies that a further appointment should be offered on clinical grounds. If the patient DNAs a second time, a further appointment will not be given.
6.3.5 Cancer target patients should not be referred back to the GP after any cancellations or DNAs unless the referral has been reviewed by a clinician and discussed with the patient and/or the GP.
6.3.6 There is a separate policy for the management of cancellations or DNAs for children – see Section 10.
6.3.7 Cancellation of appointments by the hospital should be avoided wherever possible. If this is unavoidable due to sickness of key staff or exceptional circumstances, then every effort should be made to offer patients as much notice of cancellation as possible.
6.3.8 Clinics should not be cancelled due to planned annual/study leave where sufficient notice has not been given. Clinical staff are required to give notice of annual or study leave in line with the Medical Staff - Annual Leave Policy.
6.4 / Diagnostics
6.4.1 Patients waiting for a diagnostic outpatient appointment will be offered a maximum of two dates with at least one week’s notice and patients waiting for an inpatient diagnostic procedure will be offered a minimum of two admission dates with at least three week’s notice for the offer to be considered reasonable.
6.4.2 The Trust will work to the national standard of six weeks maximum wait for diagnostic tests.
6.4.3 Reporting turnarounds should not exceed 7 days.
6.5 / Inpatients and Day Cases
6.5.1 Patients who are added to the active waiting list must be fit, ready and able to come in.
6.5.2 If the patient is unfit at the time of listing, with the exception of short term, self-limiting illnesses (e.g. cold, flu) to a maximum of four weeks, the patient should not be placed on the waiting list and should be referred back to the GP for management of their condition.
6.5.3 Patients must not be added to the waiting list for procedures listed in the Policy on Procedures of Limited Clinical Value and East Midlands Commissioning Policy for Cosmetic Procedures.
6.5.4 All patients for elective treatment must be placed on the appropriate waiting list on PAS within one working day of the decision to admit.
6.5.5 For non-contracted activity where prior funding approval is required the patient should not be added to the waiting list until funding has been approved.
6.5.6 Patients who require a treatment or set of treatments at a given interval or require their condition to progress to a certain point e.g. age related, before treatment should be added to the planned list and should have a date by which treatment should commence recorded on PAS. Any patient that has not received their intended procedure by the date the treatment was planned will become active on the RTT pathway.
6.5.7 Patients should be offered a minimum of two admission dates with at least three weeks notice unless the patient agrees to accept a date at short notice.
6.5.8 Patients must be dated in order of clinical priority and then in order of their 18 week guarantee date or other relevant standard (e.g. diagnostic).
6.5.9 To come in (TCI) dates must be recorded on the relevant hospital systems (PAS and ORMIS) at the same time and within 24 hours of agreeing the date with the patient.
6.5.10 Patients can be removed from the waiting list for a variety of reasons including a clinical decision not to treat, the patient declining treatment or as a result of the cancellation, DNA or suspension rules described in this Policy. If it is felt that a patient should be removed for any other reason, the appropriate manager and/or clinician’s advice should be sought and documented before removal.
6.5.11 If a patient requests time to consider their options for surgery for a reasonable period of time (up to 2 weeks), they should not be removed from the waiting list until a decision is made. If the patient is removed at their request and then decides to proceed to surgery at a later date, they may be able to go back onto the waiting list in line with the fast tracking procedure described above.
6.5.12 It is good practice to contact patients on a waiting list (this includes patients waiting for treatment in an outpatient setting) at regular intervals to confirm that their contact details are up to date and that they still wish to have treatment (validation). Patients should receive a letter asking them to respond within a reasonable timescale, which should be no less than three weeks. If they do not respond within this timescale, they can be removed from the list.
6.6 / Inpatient Cancellations and DNAs
6.6.1 If the patient cancels an agreed admission date, a second reasonable offer will be made, taking into account clinical priority and their relevant guarantee date.