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1 Policy No: OP12 Version: 7.0 Name of Policy: Patient Access (Waiting List/Waiting Times) Policy Effective From: 18/04/2018 Date Ratified 27/03/2018 Ratified Finance and Performance Committee Review Date 01/03/2020 Sponsor Director of Strategy and Transformation Expiry Date 26/03/2021 Withdrawn Date Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version This policy supersedes all previous issues

2 Version Control Version Release Author/Reviewer Ratified by/authorised by 1.0 Date Changes (Please identify page no.) 2.0 June 2006 Trust Policy June 2006 Forum 3.0 March 2007 BSDC March Aug 2008 BSDC Aug /12/2009 Steve Atkinson BSDC 05/10/2009 Sharon Pearson /02/2014 Julie Rush Patient, Quality,Safety & Risk Committe 17/01/ /04/2018 Julie Rush/Denise Reay/Steve Lawson Finance and Performance Committe 27/03/2018 Full review following internal audit, updated guidance and recommendations from NHSI/NHSE access policy master class Patient Access (Waiting List/Waiting Times) Policy v7 2

3 Contents Section Page 1 Introduction Policy scope Aim of policy Duties (Roles and responsibilities) Referral Management Appointment Management Appointment Booking Management 6.2 Capacity and appointment slot issues 6.3 Patient cancellations 6.4 Clinic attendance 6.5 Clinic outcome 6.6 Did not attend 6.7 Patient Transport 6.8 Clinic administration 6.9 Clinic format 6.10 Clinic change management 6.11 Outpatient waiting list validation 6.12 Management of Inpatient & Daycase waiting list 6.13 Treatment management 6.14 Inpatient & Daycase cancellations and suspensions 6.15 NHS Constitution/Patient Choice 7 Training Equality and diversity Monitoring compliance with the policy Consultation and review Implementation of policy (including raising awareness) References Appendices Patient Access (Waiting List/Waiting Times) Policy v7 3

4 Patient Access (Waiting List/Waiting Times) Policy 1. Introduction This Policy is issued and maintained by the Director of Strategy and Transformation on behalf of The Trust, at the date identified on the front sheet, which supersedes and replaces all previous versions This is the Trust Patient Access (Waiting List/Times) Policy (OP12) for Gateshead Health NHS Foundation Trust. The document has been developed with consultation throughout the local health community and supports the NHS Plan. This has included partnership working across the whole Health Community The successful management of patients who wait for all appointments and elective treatment is the responsibility of a range of staff working within all sectors of the NHS, including Trust staff, Commissioners, GP and patients. Service commissioners must ensure that service agreements are established with sufficient capacity to ensure that no patient waits more than the guaranteed maximum time specified in the NHS Plan. Hospital medical staff, managers, secretarial and clerical staff all have an important role in treating patients delivering a high quality, efficient and responsive service and managing waiting lists effectively This policy is a reference document which applies to the management of all waiting lists held by Gateshead Health NHS Foundation Trust inpatient, day case, outpatient, therapy and diagnostic services and must be adhered to by all staff. The policy will be available to all those involved in organising access to the Trust s services including the general public It is the Trusts intention to continue to modernise its outpatient and inpatient treatment management systems in line with the NHS Plan. A range of booking systems have been developed to support this. National developments such as NHS e-referral Service and local systems such as ICE Pathology and Radiology requesting tools have been rolled out in collaboration with General Practitioners, CCGs and Trust clinical and administrative staff. The NHS Constitution came into effect 1st April 2010 and sets out the following rights for patients: The NHS is making sure that you are seen as soon as possible, at a time that is convenient for you. To do this, the NHS Constitution gives you the right to access services within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible This right is a legal entitlement protected by law, and applies to the NHS in England from 1 st April The maximum waiting times are described in the Handbook to the NHS Constitution which you can find on our website. Gateway reference: If any staff member has any queries regarding this policy they should contact their immediate line manager in the first instance. There may be occasions when situations arise which are not covered by this document. In such circumstances the appropriate line manager should be contacted. If further advice is required, guidance should be sought from the Business Unit, Associate Director or Departmental Manager for that service. The features in this policy are consistent with advice given in: NHS Improvement Plan Tackling Hospital Waiting: the 18 week pathway and Implementation Framework Patient Access (Waiting List/Waiting Times) Policy v7 4

5 RTT Consultant led watiting time Rules Suite Oct 2015 NHS Constitution Access to Services October 2015 Delivering Cancer Waiting Times A Good Practice Guide Trust Commitment The aim of this health community is to provide good access to high quality healthcare and Gateshead Health NHS Foundation Trust is committed to the following: 2. Policy scope All patients will be treated according to clinical need within the resources available To establish a consistent approach to patient access across Gateshead An integrated and sustained approach to waiting list management Systematic approach to developing referral protocols and guidelines with GP s,underpinned by regular audit to monitor effectiveness Effective two way communication with patients and their GP Quality of information both internally and externally Continual improvement in the effectiveness and efficiency of current services dependent upon resources; and Pooling of an agreed range of procedures between consultants. The Trust will state its responsibilities for access times and patient information. Similarly patient responsibilities will be clearly identified 2.1 The Business Unit Associate Directors, Managers and Departmental Heads for all business units are responsible for ensuring that the policy is effectively implemented through the Business Unit management structure and for reviewing the policy on an annual basis. 2.2 All OPD booking areas and reception areas will carry out periodic audits to ensure compliance with the Policy. Audit outcomes will be shared at the Data Quality Strategy Meetings. 2.3 The Director of Finance and Information has the responsibility for ensuring that mechanisms are in place to enable the Trust to collect data accurately and ensuring that systems are available to do so 2.4 The policy and subsequent amendments will be approved by the Finance and Performance Committee, Clinical Policy Group for clinican sign off, and the CCG. The policy will also be taken to a public meeting of the board. 2.5 The Business Unit Associate Directors and Managers along with the Departmental Operational Managers have the responsibility to ensure that patients are monitored and managed in accordance with this policy and the procedural guidelines, which underpin the policy 2.6 The clinical management of individual patients on the waiting list is the responsibility of the clinician in charge of the patient s care 2.7 GPs/referrers have a responsibility to provide accurate and complete information within referral letters, use referral templates where available and identify any patient special needs (including war pensioners). To minimise waits and maximise access, GPs/referrers are encouraged to make pooled/open referrals to a clinical specialty/sub-specialty. 2.8 Patients are responsible for complying with booking arrangements, attending appointments and ensuring that the Hospital is informed of any relevant changes in circumstances Patient Access (Waiting List/Waiting Times) Policy v7 5

6 Key Principles As a Trust which promotes diversity and inclusion, both as an employer and service provider, the Trust will: Support staff in providing the best possible quality of care to patients, and to treat patients, carers, and relatives with dignity and respect, taking into account issues, interpretations and where possible, the specific needs of people from different race, faiths, cultures, genders and people with disabilities Ensure that staff develop an awareness of policies to promote equality and of the legislative requirements affecting patient groups Review practices and procedures to ensure that services are accessible Ensure reasonable adjustments are made where necessary to accommodate the needs of people from different race, gender and people with disabilities Have robust plans developed in collaboration with the CCG and wider health economy to achieve and maintain access standards/waiting times set by the Department of Health/NHS Improvement. Ensure the management of patients on waiting lists will be equitable and transparent Ensure patients are treated in relation to their clinical need and in accordance with their rights to timely treatment as specified in the NHS Constitution Add patients to a waiting list if they are clinically deemed fit to have their operation within the maximum waiting time guarantee Offer patients choice of appointment and admission date within a reasonable time Ensure patients of the same clinical priority will be offered dates for treatment in chronological order with the exception of patients showing flexibility to accept short notice appointments due to short notice cancellations Referral guidelines will continue to be developed alongside systems to feedback on appropriateness of referrals; for services and those who make referrals Have appropriate and effective booking systems across all specialties Communication with patients at all stages should be informative, timely, unambiguous and concise All policies, procedures and performance information will be made widely available, including to the general public (unless there is a specific reason for restricted availability) Accurate and up to date information about the outpatient and direct access services provided by the Trust will be included on the NHS e-referral Service, Directory of Services (DoS) The Trust will offer outpatient appointments to ensure that there is availability for new referrals to be seen in a timely mannerand to ensure the hospital remains on the choice menu for local referring GPs National Waiting Times Standards The Trust is required to achieve the waiting time standards stated in the NHS Constitution and detailed in the NHS Consitution handbook. For more information on the NHS Constituion and the detail of the waiting time standards please click on the links below: tution_handbook_v2.pdf Key National access targets associated with the waiting time standards are frequently reviewed and can be found in the most recent versions of the NHS Single Oversight Framework in the link below: Patient Access (Waiting List/Waiting Times) Policy v7 6

7 Wherever possible the published National Waiting Times Guidelines on reasonableness for written and verbal offers of appointments and admission offers will be followed (Appendix 2). 3 Aim of policy 3.1 The length of time a patient waits for hospital treatment is an important quality issue and is a visible and public indicator of the efficiency of the hospital services provided by the Trust 3.2 The successful management of patients who are waiting for elective treatment is the responsibility of a number of key individuals and organisations including Clinical Commissiong Groups, General Practitioners, Hospital Doctors, and Trust Managers. If patients who are waiting for appointments or treatment are to be managed effectively it is essential for everyone involved to have a clear understanding of their roles and responsibilities. Patients also have responsibilities for complying with the booking systems in place. 3.3 This policy defines those roles and responsibilities and establishes good practice guidelines to assist staff with the effective management of outpatient and inpatient waiting lists. Data quality is the responsibility of all involved in the care pathway including clinical staff, service management and administration. The assurance of data quality and coordination of required improvement actions is the responsibility of the Trust s Head of Information and Data Quality. 3.4 Data capture, processing and reporting must accurately reflect working practice and be in accordance with the data principles contained in the Data Protection Act (1998) 3.5 The Trust will manage data quality issues as per the Data Quality Strategy ernance%20policies.aspx?view={f3c bf-44e3-873b- 0a73a1f6b3f1}&SortField=LinkFilenameNoMenu&SortDir=Asc 3.6 This policy applies to all waiting lists managed by Gateshead Health NHS Foundation Trust including inpatient, day case, outpatient, therapies and diagnostic services. 4 Duties - roles and responsibilities The application and implementation of this policy is the responsibility of all staff and services relating to patient access managed by Gateshead Health NHS Foundation Trust. All staff involved in the management of patients access to services within the organisation are expected to follow this policy and associated operating procedures. Trust Board Responsible for ensuring there is a robust system of Corporate Governance within the organisation. Chief Executive Ultimately responsible for ensuring effective corporate governance within the organisation and has overall responsibility and accountability for delivering access targets as defined in the NHS plan, NHS Constitution and NHSI Improvements Single Oversight Framework. Director of Finance and Information Will ensure that systems and mechanisms are in place to enable the Trust to capture data accurately and the appropriate reports are compiled and distributed on a regular basis to facilitate patient care is delivered within the standards set in the NHS constitution. Patient Access (Waiting List/Waiting Times) Policy v7 7

8 Head of Information and team Produce regular operational reports to monitor waiting times, Patient Tracking Lists (PTL s) and dashboards on the delivery of the 18 week Referal to Treatment (RTT), Cancer and Diagnostic waiting times. Provide support to ensure high data quality, including standard operating procedures and appropriate training, and provide assurance of the data quality of key indicators. Systems Manager and System Administrators Provide initial and ongoing systems and RTT training when changes to guidance or systems occur ensuring training records are kept up to date. Provide ongoing advice and support staff within Business units on RTT standards, queries and issues. Head of Performance and team Work with business units to manage delivery of access standards and providing analytical support to do so (e.g. capacity and demand analysis). Provide Trust-wide management of risks to the delivery of national access standards with regular reporting to CMT and the Board. Service Line Managers (SLM) Will be responsible for overseeing the operational management of waiting lists to ensure the principles outlined in the policy are applied. Will ensure overall capacity meets inpatient, outpatient, daycase and diagnostic demand within the constraints of the waiting time targets, service level agreements and contracting levels linked to consultant job plans Clinicians Will be responsible for the timely review or triage of referrals and diagnositic requests received into the Trust in accordance with the policy timescales (where review is determined appropriate by the service), ensuring cover arrangements are in place when clinicians are unavailable due to annual leave commitments. Support Service Line Managers with capacity and demand planning to ensure all patients are seen within the agreed local and national access standard waiting times. Ensure 6 weeks notice is given prior to the cancellation of any outpatient, inpatient and diagnostic activity and provide alternative dates to reduce impact service delivery. Ensure completion of clinic outcome slips capturing appropriate RTT status and outpatient procedure coding. Waiting List Managers, Adminstration Managers and Secretaries Each business unit will have members of staff that will have direct involvement or responsiblity in monitoring and tracking of patients through RTT pathways. This will be determined at speciality level and SLMs will be responsible for ensuring the staff group provide the following: Manage waiting lists and patient pathways in line with waiting time standards, liaising closely with clinicians, SLMs and the centralised booking team to ensure all patients are accounted for and booked appropriately, through ongoing review. Ensure referral contracts are added within 24 hours of receipt if received directly into secretary/consultant offices instead of centralised booking team to ensure RTT pathway start dates are recorded and tracked as soon as possible Patient Access (Waiting List/Waiting Times) Policy v7 8

9 Proactively monitor capacity and demand highlighting capacity shortfalls timely to SLMs and clinicians to avoid waiting times being compromised and ensure choice of dates are available within deemed reasonable notice period for type of referral ( ie urgent, routine). Validate patient pathways to ensure activity and waiting times are accurate in line with current national guidance. Attend 18week RTT tracking meetings and Data Quality Strategy meetings Appointments Managers/ administrators Will ensure all referrals received into the Referral and Booking Management Centre are processed timely and appointments booked according to clinical prioirity and/or chronological order using QM08 reporting tools. Will highlight capacity shortfalls to the relevant waiting list manager as soon as apparent using daily Appointment Slot Issues notification and 2ww reports in the first instance. Reception staff/ward staff Will ensure all patients attending are recorded correctly on PAS systems, using Postive Patient Safety ID checks. Will update outcomes and RTT status where required (or discharge or transfer) on day of attendance/discharge or within 24 hours if activity takes place out of core working hours. Arrange follow up at the direction of the clinician following attendance GPs and Clinical Commissioning Groups GPs and Clinical Commission Groups have a pivotal role in ensuring patients are made aware during their consultation of the likely waiting times for a new outpatient consultation and the need to be contactable and available when referred. The CCG will be responsible for ensuring robust communication links are in place to feed back information to GPs. 5 Referral Management The Trust s preferred referral route for GP referrals is via the NHS e Referral Service and this is the mandated route for receipt of all referrals to consultant led services from October 2018 as outlined in the variation to the NHS Standard Contract A. Where services are not available, paper referrals (i.e. , fax, post) should be received by the Referral & Booking Management Centre. However it is recognised that it may be appropriate for some referrals to be sent directly to individual business units or services A new referral must be made for a patient with an existing condition if the request for futher consultation is 6 months after the discharge of the original referral unless the patients has been given a time specific SOS appointment Referrals and requests should be triaged within 3 working days of receipt, where possible using the Windip Workflow module, e-referral service or Carestream and returned to the Referral & Booking Management Centre for processing. Business units must work with consultants to ensure that here are contingency arrangments in place to cover periods of consultant annual leave, study leave and sickness to prevent delays in triage. Where services are offering Advice & Guidance through NHS e-referrals a response must be provided to the referring GP within 5 working days as per contractual agreements. Patient Access (Waiting List/Waiting Times) Policy v7 9

10 5.1.4 GP referrals for consultant led services received outside of the NHS e-referral Service by services should be sent immediately to the Referral & Booking Management Centre to enable the appropriate returns process to be initiated as per the variation to the NHS Standard Contract A. All other referrals received directly into services (consultant offices) should be date stamped, added to the relevant PAS system and triaged on receipt. Referals should then be sent electronically using agreed internal mailboxes and/or systems to the Referral & Booking Management Centre to process where appropriate. Cancer Referrals The quality of suspected cancer referrals will be subject to regular review within the clinical teams with appropriate feedback to the GPs and CCGs GP s will be encouraged to clearly identify referrals which are suspicious of cancer by use of standardised tumour specific referral proformas recommended by NICE and regional Cancer Network Groups (Cancer Operational Policy OP90) Rapid access facilities exist for receiving cancer referrals via the NHS e-referral service or an indentified fax or NHS.net account following agreed security protocols. Timely dispatch of referrals to these faciliites will ensure the fast tracking of appointments as well as avoiding duplication Patients who are referred with suspected cancer must be seen within 14 days of the receipt of referral and offered 2 dates within this period Patients should have a maximum 1-month wait from diagnosis (date of DECISION TO TREAT) to first definitive treatment for all cancer (31-day target) and a maximum 2-month wait from urgent GP referral for suspected cancer to first definitive treatment for all cancers (62-day target). Cancer waiting targets: Guide Version 8 Tertiary Referrals/ Consultant to Consultant (C2CR) The Newcastle and Gateshead CCG, C2CR Policy states that to allow choice and treatment to be provided by the best placed clinician, secondary care clinicians should not refer directly to internal colleagues except in specific circumstances described below. Instead they should write to the GP and/or originating referrer to advise on appropriate treatment and further management. Many conditions can be managed by the skills available in primary care and do not require secondary care input until these have been completed. Letters back to primary care may be used as the onward referral letter if they agree that an onward referral is needed so secondary care teams are asked to include any detail a future specialist may need. The full policy is available in appendix Appointment Management All outpatient and diagnostic appointments will be managed on the appropriate patient administration system and information regarding the status of the appointment recorded at every opportunity (appointment declined, cancelled and appropriate reasons) All patients will be booked according to clinical priority. Patients of the same clinical priority will be offered appointment dates for treatment within chronological order with the exception of patients showing flexibility to accept short notice and utilisation of appointment slots due to short notice cancellations. Patient Access (Waiting List/Waiting Times) Policy v7 10

11 6.1.3 The Trust will endeavour to contact patients to verbally agree a date and time for those patients requiring short notice appointments (within 14 days). Attempts will be made over the course of a working day up until 8pm. If the patient cannot be contacted the appointment will be booked and a confirmation letter will be generated from the appropriate booking system providing details how to rebook if the date is inconvenient For an written appointment or admission to be deemed reasonable, the patient is to be offered a date with a minimum of 3 weeks notice. In addition to the 3 weeks notice, for a verbal appointment or admission offer to be deemed reasonable the patient is to be offered a minimum of 2 different dates. (DSCN07/2003 guidance Appendix 2). This does not apply to patients offered short notice appointment due to clinical need Referrals generated from HM Prisons will receive a fixed appointment and this will always be addressed to the Medical Officer of the prison establishment. Security will be informed that a prisoner will be on site to liaise with Prison Service where required Appointments for patient s requiring interpertering services will receive a fixed appointment with details of how to rebook, in the preferred language where possible All appointment letters will have details of the contact numbers for patients requiring additional support with their appointment (easy read information etc.,) In the event of the Trust having short notice availability, this will be offered to patients but non-acceptance will not compromise the patient s position in terms of the reasonableness criteria as stated above The NHS e-referral Service enables patients to fully book directly into a consultant s outpatient clinic at the time the decision to refer is made (i.e. at the GP practice). Patients can also book at a later date via The Appointments Line (TAL) or on-line via the HealthSpace website: War pensioners should receive priority treatment, both as Outpatients and Inpatients with the condition(s) for which the war pension has been given (Appendix 4 ) Military veterans should receive priority access to NHS secondary care for any conditions which are likely to be related to their service subject to clinically needs of all patients (Appendix 4) Patients who fail to respond to an appointment offer within the required timescales (partial booking processes) will have their referral letter returned to the referring clinician 6.2 Capacity and appointment slot issues (ASIs) Where patients cannot be allocated an appointment or where slots are no longer available within the NHS e-referral Service within the agreed waiting time, due to unavailability of clinic slots, the appropriate Service Line Managers, Associate Directors and Waiting List manager will be informed. Patients will be contacted by telephone or sent an acknowledgement letter (Receipt of Referral) to let them know their request for an appointment has been received by the trust The Referral and Booking Management Centre will send the following reports : Daily Appointment Slot Issues reports showing patients unable to directly book Patient Access (Waiting List/Waiting Times) Policy v7 11

12 Daily 2ww Cancer DQ report showing patients referred on the 2ww Cancer pathways who are unable to directly book due to capacity issues or who have booked beyond 14 days to enable business units to manage individual patients. QM08 report showing all referrals that require an appointment booking (minimum weekly or as required) 6.3 Patient cancellations (CNA) If the patient has never been seen and advises they do not wish to progress their pathway, they will be removed from the relevant waiting list and a clock stop and nullification applied. The patient will be informed that their consultant and GP will be informed of this Patients who cancel their first new appointment should be given an alternative date at the time of cancellation. Patients originally referred on a 2ww cancer referral must be given a further appointment within 14 days Patients who have cancelled and/or rebooked their appointment more than twice will be monitored by the Business Unit using the Multiple Consecutive Cancellations Report available in the Business Intelligence Suite. Having been identified the patient should be subject to a clinical review within the Business Unit and may be discharged back to the GP if it is clinically safe to do so or offered a further appointment date The appointment confirmation letter will clearly state that should a patient cancel their appointment twice they may be discharged back to their GP under the process described in Patients referred on the 2ww fast track pathway will not be routinely re-appointed following a second cancellation. An appropriate member of staff nominated by the business unit will contact the patient to establish the reasons for cancellation. If the patient refuses to keep an appointment and is unable to co-operate within a reasonable time frame then the conversation between the Trust and the patient will agree that a return to the GP care is the most appropriate course of action. A standardised 2ww CNA letter will be generated from the appropriate booking system and sent to the GP within 48 hours of the decision If the patient is unable or refusing to co-operate within a reasonable time frame and this remains unresolved the patient will be informed by the Business Unit that a letter of non/or delay appointment will be sent to the advise the GP. A letter from the consultant will inform the GP of the reason given for a requested delay by the patient. This letter will be sent within 48 hours of contact with the patient for the GP to decide if the patient should be downgraded from the 2 week wait referral pathway If a new or follow up patient informs the Trust that they cannot attend as they have been admitted as an inpatient to a hospital, the administrator taking the call will inform the relevant consultant of the circumstances and seek advice as to further action required. Locally agreed process within the specialities and departments should be in place. 6.4 Attendance at Clinic On arrival at the appointment, the reception clerk will check to ensure that the details recorded on the pre-registration form are checked and amendments made on the appropriate system if required. To ensure compliance with national standards for data collection. If the patient fails to bring the pre-registration form, Postive Patient ID checks will be made at that time. Patient Access (Waiting List/Waiting Times) Policy v7 12

13 6.4.2 For patients who have identified that they have not lived in the UK for the past 12 months the Finance Department should be contacted immediately. Further guidance can be found in the Treatment of Overseas Visitors & Asylum Seekers Policy OP11b Where possible, diagnostic tests should be carried out and results made available before or during the patient s attendance at outpatients to reduce the number of visits and inconvenience caused to patients As identified by medical staff, all patients who attend outpatient/endoscopy clinics will have their outcomes recorded in their health records and on the PAS system Clinic outcome slips should be completed by the clinician in clinic identifying status of the RTT pathway and any outpatient procedures that have been carried out at that attendance. The reception clerk will then transpose this information into the relevant system to ensure RTT timescales can be monitored accurately Patients attending the Endoscopy unit for procedures will be recorded as inpatient activity in the Endoscheduler with the exception of Urology patients. These patients will be recorded initially on PAS as an outpatient, enabling the Trust to continue to receive referrals via NHS e- Referral service. For the episode to be recorded accurately on the day of the procedure this will be recorded on PAS as an inpatient episode. The Trust booking teams will remove the outpatient episode and ensure the inpatient episode is captured. Local SOPs will be in place within the Endoscopy Unit and the Referral & Booking Management Centre to support this process Arrangements for follow up care will reflect the need to minimise the long-term surveillance follow-up in preference for an early referral back to primary care; and where appropriate/suitable the follow-up care will be provided by an alternative professional i.e. specialist nurses/technical staff All follow up patients will be offered choice of appointment and venue at the time of leaving the clinic if the patient is to return to the Outpatients within 12 weeks or via a partial booking process where appropriate Where it is necessary to issue a patient with an Open Out-Patient Follow-up Appointment (SOS), the patient will be advised of the timescales in order to re-access the system and this will be noted on the PAS system. Urgent Inpatient follow up/discharge Appointments Wards will liaise with the relevant booking team to agree an appointment date, time and venue on behalf of the patient. Routine Inpatient Follow-up/Discharge Appointments Wards will requests to relevant booking team with relevant instructions. The booking team will then contact patient to agree a sutiable appointment All suitable patients will be contacted by the Trust Remind/Confirmation service 4-7 days in advance of their planned appointment and will be asked to confirm their attendance, cancel or re-arrange their appointment. Patients are given the choice to opt out of this service if they do not wish to receive a remind/confirmation call. Patients may receive an automated call, SMS message or agent call depending on service agreements. Patient Access (Waiting List/Waiting Times) Policy v7 13

14 6.5 Clinic Outcome Management It is the responsibility of the medical staff in clinic to ensure that all patients have a clinic outcomes instruction slip completed at the end of their consultation The outcome will indicate attendance, procedures performed in clinic and subsequent actions with timescales required (ie follow up, diagnostic appt, discharged) All patients booked into a clinic will have an outcome recorded on PAS against their attendance The information given on the outpatient clinic instruction slip will be recorded on PAS within 24 hours of the patient s attendance at clinic or as soon as practically possible for domiciliary clinics Written communication in the form of outpatient clinical letters will be sent to the GP/referrer and patient, from the clinician within 10 working days of the clinic (Copying clinical letters to patients policy OP18). 6.6 Patients who do not attend an outpatient appointment (DNAs) Please note, the below processes are the minimum standards that will be expected across services. Locally some services will have additional steps depending upon clinical pathways. Where this is the case those services will be responsible for managing this process Non-attendees (DNAs) are patients who fail to attend and provide no advanced explanation or warning Appropriate administrative checks should be undertaken to ensure that patient details are accurate and up to date Patients who DNA their 1 st new appointment will be invited to contact the Trust to rebook their appointment within an agreed timeframe (Appendix 5). This excludes cancer and children s referrals where relevant legislation overrides this If the patient fails to respond in the agreed timeframe the patient will be discharged and removed from the Outpatient Waiting list. The patient and referring clinician (including patient GP where they are not the referring clinician) will be sent an explanatory letter Patients who DNA a second new appointment, will be discharged and removed from the Outpatient Waiting list. The patient and referring clinician will be sent an explanatory letter. The letter will give the GP the option of re-referring to request a further appointment Patients who have been referred via the two week wait referral pathways must be reappointed within two weeks. (Cancer Operational Policy OP90) Patients referred on a 2ww referral pathway who have multiple DNA s/cancellations (2 or more) will be contacted by an appropriate member of staff nominated by the business unit to identify any factors that may be stopping the patient attending. Another appointment will be offered if the patient agrees. Patients can be discharged back to the GP after multiple DNA s/cancellations (2 or more) if this has been agreed with the patient. Patient Access (Waiting List/Waiting Times) Policy v7 14

15 6.6.8 Patients who do not attend a follow up appointment may be offered a further appointment at the consultant s discretion. Given the potential child protection issues around the nonattendance of children, this system will also apply to paediatric patients If a patient DNA s their first appointment and a second appointment is offered, the reported waiting time will be from the date that the patient agrees the new appointment date (RTT Rules Suite October 2015). 6.7 Patient Transport A patient is only eligible for provision of transport (PTS) providing they meet the eligibility criteria. The Trust is not responsible for the decision making within this process and patients will have the right to appeal. See PTS Eligibility Criteria FAQ (Appendix 6) New and follow up patients or their advocates are required to contact NEAS directly where they will be assessed to determined if the patient fits the criteria When patients have transport booked, the ambulance service must be notified of any amendments to the patient s appointment by the patient themselves as indicated in the patient s appointment letter Any patient who arrives for their clinic appointment by patient transport up to 20 minutes beyond their planned appointment time will be seen in clinic as soon as possible but made aware that they may be required to wait until the end of clinic. Patients should not be sent away without being seen Reception staff will ensure NEAS are informed when the patient is ready to be collected. 6.8 Clinic Administration Clinicians, Associate Directors, or a designated person should review booking rules on an ongoing basis in line with the Consultant Job Plan to ensure that they remain relevant both to the needs of clinical practice as well as waiting list management. Any changes to clinic arrangements must be agreed with the Associate Director The rules governing the booking of outpatient appointments should be established by the clinician responsible for the clinic in consultation with the Associate Director and Service Line Manager and must ensure that all new patient slots are released to NHS e-referrals Service for all consultant led services as per national guidance (CQUIN). 6.9 Clinic Formats The following booking rule management applies to all clinic formats; Set type and number of slots available on each clinic (format) Set amount of consultation time available which informs capacity and demand management Should take into account the number of clinical staff undertaking the work including clinical nurse specialists and other professions Identify the specialty codes and treatment codes required Inclusion in the reminder/confirmation service Booking rules should reflect appropriate levels of capacity for new and follow-up consultations. Variances in new to follow up numbers should be monitored by Associate Directors. Patient Access (Waiting List/Waiting Times) Policy v7 15

16 6.9.3 Clinic utilisation and productivity will be regularly monitored by the Associate Directors and should plan and regularly undertake a systematic analysis of performance against: Start/finish times Fully booked New to follow-up ratio Productivity DNA and cancellation rates Conversion of outcome (demonstrates effectiveness of the clinic by patient outcome), including conversion rate and discharge Information given to patients Booking rule configuration will be agreed with the Service Line Managers and the Associate Directors in agreement with each consultant and Business Unit Wherever possible, generic booking rules should apply across a specialty Booking rules will be routinely reviewed at least on an annual basis with Business Unit staff with consideration given to discussions related to the Local Delivery Plans In the event of changes to booking rules being required outside the six weeks notice period, SLMs and Associate Directors should agree and authorise changes prior to submission to the Directory of Service Team (DoS). Requests for change will be actioned by administrative staff on the assumption this authority has already been given Requests for new clinics to be set up on the relevant PAS systems should be received by the Directory of ServiceTeam at least 6 weeks before expected start date or the approximate waiting time for the service In line with NHS e- Referral Service, clinic capacity will be reviewed on a continuous basis and polling ranges will be published as determined by speciality requirements. Service Line Managers will be notified on a regular basis of any additional capacity requirements Clinic Changes (Cancellation, reformats, reductions,additions) For all clinicals sessions held within Medway PAS, the cancelled clinic change proforma available via the intranet must be fully completed by the relevant consultant secretary or responsible person for the business unit. For all other PAS systems locally agreed processes must be followed A minimum of six weeks notice of planned clinic cancellations, reformats or reductions must be given by all clinic staff, together with the reason for such cancellation this include on call commitment, audit sessions, or planned annual leave of professional leave It is the responsibility of the individual business unit to identify on the proforma where patients are to be rebooked and also to manage any capacity issues resulting from these changes Any potential breaches caused as a result of clinic amendments will be managed within the individual business unit Only in exceptional circumstances should a patient that has been previously cancelled be cancelled a second time. Patient Access (Waiting List/Waiting Times) Policy v7 16

17 Where an appointment is cancelled by the Trust, an apology will be given to the patient by the appropriate outpatient support staff on behalf of the consultant (letter). Every effort should be made to ensure that the patient is offered another date as soon as possible For cancellations that are initiated by the Trust, patients should be re-booked as close to their original appointment date as possible. Service Line Managers will receive monthly performance dashboards showing cancelled /reduced clinic activity When clinics or sessions are cancelled or reinstated or additional waiting list initiatives requested within 5 days prior to the date of the clinic, secretaries should assist the booking staff, to contact patients advising them of the changes. Clinics should not be re-instated without the prior agreement of the appropriate nursing support teams Outpatient Waiting List Validation All patients will be either fully or partially booked manually or directly booked by the NHS e- Referral Service, which forms part of the validation process As a result of ongoing validation and in accordance with agreed protocols patients will be removed from the outpatient waiting list in accordance with RTT guidance The NHS Constitution mandates that patients are seen within maximum waiting times, processes have been put into place to investigate any patient queries regarding their right of access within maximum waiting times. It is the responsibility of all Business units to ensure these investigations are completed within the agreed timescales and using the investigation proforma. (appendix 6) 6.12 Management of Inpatient and Daycase Waiting Lists In line with national and local guidance the Trust is committed to offer all patients a booked admission (Appendix 8). All patients will over time, be offered the opportunity to agree a booked date for their procedure at the time when a healthcare professional has indicated this procedure is required, usually at the time of the Outpatient appointment. At this point all patients should be added to the Waiting List with an agreed booked date Patients who receive regular checks or treatments as part of a planned programme of care, are classified as planned admissions and are not reported on the Waiting List Return but are recorded on the system The computerised waiting list system will be used as the primary tool for waiting list management to ensure consistency and standardisation of reporting The intended management data item on the patient administration system is a crucial part of the Trust s overall activity planning process. Only patients who have intended management of day case will be counted as day cases. Therefore it is very important that there is a reasonable expectation of no overnight stay the patient is registered as a day case. Patients will be listed as intended day cases in relation to their procedure Treatment Management Patients will be registered on Waiting Lists in accordance with National Data Definitions (Appendix 1). Patient Access (Waiting List/Waiting Times) Policy v7 17

18 Clinical priority must be the main determinant of when patients are to be admitted as daycases or inpatients Details of listed patients must be entered onto the computer system within 1 week of the decision to admit being made Each entry must be categorised into clinical priority (urgent, routine or planned) which should reflect the patient s need for surgery. Each speciality should have a documented definition for urgent and routine The appropriate departmental staff will add patients to the waiting list on behalf of the consultant and refer to the PAS training manual prepared by the Information Dept Medical staff must make clear to the patient the proposed treatment Patients requiring prioir commissioner approval: As part of NewcastleGateshead CCG value based clinical commissioning an Individual Funding Request (IFR) policy is in place/development for low clinical value interventions. A list of specific procedures exists for which IFR is applicable. This is not a fixed list and will be amended over time as per NICE recommendations and agreed local policy. Clock stops can only be made to a patients RTT pathway when treatment occurs or a decision to not treat has been made. No adjustments or clock stops can be made to a pathway whilst a panel or approval board assesses commissioner approval requests. Patients who require treatment which must have commissioner approval to commencement must not be disadvantaged by having their referral returned to primary care. Therefore the referrer to the Trust must seek prior approval before referring the patient. The approval must accompany the referral. In some instances it will not be apparent until the outpatient consultation or on completeion of diagnostic testing, that the patient requires an excluded procedure. Commissioners should hold approval panels in line with the 18 week timeframes for any patient referred for assessment who has already commenced an RTT pathway Patients should only be confirmed on the waiting list if: There is sound clinical indication for an operative intervention requiring a hospital bed as either an inpatient or day case, and The patient is clinically and socially ready for admission on the day the decision to admit is made, or Should patients contact the trust to communicate periods of unavailability for social reasons (e.g. holidays, exams), this period should be recorded on PAS. If the length of the period of unavailability is equal to or greater than a clinically unsafe period of delay (as indicated in advance by consultants for each specialty), the patient s pathway will be reviewed by their consultant. Upon clinical review, the patient s consultant will indicate one of the following: o Clinically safe for the patient to delay - continue progression of pathway. The RTT clock continues. Patient Access (Waiting List/Waiting Times) Policy v7 18

19 o Clinically unsafe length of delay clinician to contact the patient with a view to persuading the patient not to delay. The RTT clock continues. In exceptional circumstances if a patient decides to delay their treatment it may be appropriate to place the patient under active monitoring (clock stop) if the clinician believes the delay will have a consequential impact on the patient s treatment plan or o Clinically unsafe length of delay in the patient s best clinical interests to return the patient to their GP. The RTT clock stops on the day this is communicated to the patient and their GP. The patient could also be actively monitored within the trust. The patient will agree any provisional date within 24 hours When the decision is made that a patient requires an inpatient surgical procedure or a day case procedure, a pre-assessment date should be organised/agreed with them. This preassessment assessment should be within 10 working days of the OP Consultation when the decision for a procedure is made. At this pre-assessment appointment the following should be discussed/agreed with the patient and documented: Are available to come in at short notice (less than 48 hours) if an unexpected vacancy arises Have any special circumstances requiring longer notice than usual for admission (eg, caring for elderly relative, childcare etc) Have any dates when they will not be available for admission, eg, booked holiday, exams etc, and A date will be confirmed with the patient for their surgery A TCI date confirmation letter will be sent out by the relevant secretary and will include a patient information leaflet for that procedure Patient information leaflets relating to general information about their hospital stay and any specific information relating to their impending procedure, should be given to the patient at pre-assessment Patients must be placed on the waiting list in chronological order Where more than one procedure will be performed at one time by the same surgeon, add first procedure to the waiting list with additional procedures noted Where different surgeons working together will perform more than one procedure at one time, add patient to the waiting list of the Consultant Surgeon for the priority procedure with additional procedures noted Where patient listed for bilateral procedures, or more than one procedure, but will have initial surgery on one side at the first admission and subsequent admission for the second side or procedure: Add to the waiting list for the first side/procedure with additional procedures noted Put on a planned list for the second side/procedure Agree with patient a TCI date for the second side at pre-operative assessment Patient will be removed from the waiting list following each procedure The Peter Smith Surgery Centre PRE-OPERATIVE ASSESSMENT PROCESS Patient Access (Waiting List/Waiting Times) Policy v7 19

20 6.14 Cancellation and Suspension Rules Patients who self defer for a valid reason should be informed of the likely arrangements for their future admission. Wherever possible, they should be given a rearranged date at the time of deferral Having been removed from the waiting list following clinical review, if a GP requests that a patient is placed back onto the waiting list, a new date on the waiting list will be given. Every effort should be made to ensure that the patient is offered another date according to clinical priority. Each Business Unit must make local provision to identify how long a patient can wait depending on specialty and condition Theatre lists should not be cancelled within six weeks except through illness or other unforeseen circumstances. If cancellation is unavoidable notification should be made according to the procedures described in the Trust Operating Theatre Performance (Scheduled Sessions) Policy OP38. Failure to comply will result in an investigation led by the Business Unit Associate Director or their nominated deputy Patient Access (Waiting List/Waiting Times) Policy v7 20

21 8.pdf Where an operation is postponed by the Trust a verbal explanation together with an apology will be given to the patient by the appropriate Business Unit support staff on behalf of the Consultant. The aim must be to offer a new admission date at the time of cancellation wherever possible. Every effort should be made to ensure that the patient is offered another date as soon as possible within a maximum wait of a further 28 days If an operation is cancelled, for non-clinical reasons on the day of admission, after admission or on the day of the operation, the patient should be offered an admission date within 28 days of the cancellation. This should be noted on the waiting list record to ensure that this patient is not cancelled again. Operations cancelled on the scheduled day for non-medical reasons, form part of the national reporting standard of Trust s Performance Indicators If patients are cancelled for medical reasons arrangements should be made for the patient to receive remedial treatment and a review arranged for the patient to attend pre-operative assessment or the consultant depending on clinical need. The patient s RTT clock will continue to tick until a clinical decision is made to not treat. If a decisison is made to not treat, then the clock will stop and the patient will be referred back to the care of their GP (and/or initial referrer). Where there is a decision made not to treat, but to retain clinical responsibility for the patient (for regular outpatient follow-ups etc) then it may be appropriate to start a period of active monitoring which will also stop the patient s clock NHS Constitution / Patient Choice Patients who may potentially wait longer than 18 weeks may be eligible for choice at the discretion of their commissioning CCG (Appendix 6) The CCG will be notified of waiting times for each specialty and will identify whether any patients waiting in excess of 18 weeks should be offered choice at a different provider organisation If choice is not to be offered the patient will maintain their existing place on the waiting list and continue through the care process. They would then be reported as a breach If choice is to be offered the CCG commissioner will be required to identify an alternative provider (receiving hospital) and inform the Trust of this arrangement Any alternative offers made should be for faster treatment than would be possible in Gateshead Health NHS Foundation Trust (the originating hospital) For those patients who accept the offer of choice the Trust (as originating hospital) will provide all appropriate patient details to the receiving hospital, including access to clinical records in a timely way in order that the receiving hospital can progress treatment If a patient chooses an alternative provider and has been clinically accepted by that provider after a pre-assessment consultation, then the patient is removed from the originating hospital's waiting list and is entered onto the receiving hospital's waiting list Patients are not obliged to accept the offer of an alternative hospital and cannot be suspended for not accepting such an offer. If the patient does not agree to transfer they Patient Access (Waiting List/Waiting Times) Policy v7 21

22 7 Training will be made a reasonable offer with their responsible consultant within their original guarantee date. 7.1 To ensure high quality waiting list administration and continual maintenance of data quality, all staff involved in waiting list management will be trained by the Information Department to a standard level, tailored to the individual s responsibilities as part of an ongoing programme. 7.2 The programme will recognise differences in local administration arrangements while ensuring consistency in the implementation of this policy. Both new starter and refresher programmes will be provided on a regular basis. Associate Directors are responsible for ensuring their staff are fully trained and receive appropriate refresher training 8 Diversity and Inclusion The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat staff reflects their individual needs and does not unlawfully discriminate against individuals or groups on the grounds of any protected characteristic (Equality Act 2010). This policy aims to uphold the right of all staff to be treated fairly and consistently and adopts a human rights approach. This policy has been appropriately assessed. 9 Process(s) for monitoring compliance with the policy This effectivenss of this policy will be monitored by the indicators below Standard / process / issue End to End outpatient booking processes audit Cancelled clinic activity Cancelled inpatients activity Outpatients waiting reports Monitoring and audit Method By Committee Frequency Referrals, Booking team Data Quality Monthly Medway,EMIS, RIS and Reception Group Cancelled clinic reports provided by Information team Achieving the Targets Performance reports QM08/RTT PTL provided by Information team teams Service Line Managers Service Line Managers Waiting List managers Waiting List Managers Monthly Weekly Weekly RTT Standards RTT performance Performance Team / Information Finance & Performance Committee Monthly Long waiters Performance monitoring of 40+ week waiters Performance / service line managers Finance & Performance Committee Weekly Patient Access (Waiting List/Waiting Times) Policy v7 22

23 10 Consultation and review This policy has been reviewed in consultation with the finance and performance committee on behalf of Trust Board, Clincal Policy Group, and the CCG 11 Policy implementation (including awareness raising) This policy will be circulated by the Trust Secretary as detailed in OP 27 policy for the development and authorisation of policies The policy will be shared at the DataQuality Strategy Group. 12 References OP11a Private Patient Policy OP12 Treatment of Overseas Visitors Policy OP18 Copy letters correspondence OP38 Operating Theatre Performance (Scheduled Sessions) Policy OP38 OP90 Cancer Operational Policy Patient Access (Waiting List/Waiting Times) Policy v7 23

24 Appendix 1 Definitions Inpatients/Daycases RTT Active Waiting List Fully Booked Patients Booked admissions Inpatients Day cases Decision to Admit (DTA) Waiting List Admission TCI SOP EROD Refers to Consultant-led Referral To Treatment (RTT) waiting times, which monitor the length of time from referral through to elective treatment. For further information on RTT waiting times please visit the below link: Patients awaiting elective admission for treatment who are currently available i.e. fit, able and ready, to be called for admission Patients awaiting elective admission who have been given an admission date which was arranged by offering the patient choice and agreed with the patient at the time, or within one working day of the decision to admit. These patients form part of the active waiting list Patients who require admission to hospital for treatment and are intended to remain in hospital for at least one night Patients who attend hospital for an interventional procedure and are discharged home within the same day The date on which a Healthcare Professional confirms that a patient is fit to be admitted for an procedure. This date should be recorded on the hospital PAS system. The DTA date is the effective date when the patient waiting time commences. It is therefore imperative that this date is accurate and is recorded as the actual date the decision was made, not the date the patient was added to the list A patient admitted electively from a waiting list not having been given a date for admission when the decision to admit was made The date on which patient is due To Come Into hospital for treatment as daycase or inpatient Standard operational procedure Earliest reasonable offer date Appendix 1 (cont) Patient Access (Waiting List/Waiting Times) Policy v7 24

25 Outpatients Outpatients Partially Booked Patients NHS e-referral Service Directly Bookable Date of Receipt of Referral List (Pending) on hold lists Directory of Services (DoS) Patients referred by a General Practitioner, another Healthcare professional or self referral, for clinical advice or treatment Where a service operates a partial booking system, the patient will be added to the partial booking worklist in the appropriate timescales as instructed by the clinic outcome slip. A letter is sent to the patient at an agreed timescale (service specific) in advance of the expected due date of appointment, asking the patient to telephone the hospital. An appointment is agreed with the patient upon contacting the hospital. A confirmation letter is sent to the patient. If the patient does not contact the hospital a reminder letter is sent. If the patient fails to contact the hospital the patient is removed from the partial booking worklist and the referring clinician informed. Is a national system that allows referrers and patients to search for the provider of choice and enables and electronic booking of date and time of first consultant outpatient clinic. The patient will be able to NHS e-referral Service to book an an appointment with their chosen provider following a referral via their GP. These appointments can be made directly in the GP practice, via the National Appointments Line (TAL) or by the patient via NHS Choices website. The date on which a hospital received a referral letter from a GP or other referrer (DRR). The waiting time for outpatients is calculated from this date. The waiting time for NHS e-referral Service patients is calculated from the date of the Unique Booking Reference Number (UBRN) conversion date i.e., the date on which the patient actually booked their appointment. In the event of capacity issues within NHS e-referral Service the GP will add the patient to the Defer to Provider worklist. The DDR is calculated from the date the patient appears on this worklist. NB. For onward referrals from MSK Cats services via NHS e-referral Service where 1st definitive treatment has not been given the pathway start date (date the original referral was received into the MSK Cats service) must also be recorded A holding list of patients waiting for an outpatient appointment. The process ensures patients are seen in chronological order and have the opportunity to choose a convenient date The Directory of Service (DoS) is the core of the NHS e-referral application. It holds information that describes the types of services the Trust offers, including service specific referral criteria and guidance which enables the referring clinician to search for appropriate services to refer patients. The DoS also provides patients with a list of suitable providers for their treatment. Appendix 1 (cont.) Patient Access (Waiting List/Waiting Times) Policy v7 25

26 SNOMED Is the common language which will eventually be used by all Systematised Nonmeclature computers across the NHS. These terms are loaded each Directory of Service published in NHS e-referrals to enable referrers to search for the appropriate service without the need to use clinic types or specialities Appointment Slot Issue (ASI) Is the term given when inadequate capacity is available for direct booking via the NHS e-referral service. UBRN PAS SOS Unique booking referernce number is allocated to a referral by the NHS e-referral Service at the time the GP raises a referral in the system. Trust patient administration systems (Medway/ EMIS/ Carestream RIS/ Endosoft etc) See on request, given to patients who do not require specific follow up but have the opporturnity to arrange an appointment if the need arises within a specific time frame from their last appointment Inpatients, Day Cases & Outpatients Planned Admissions Did Not Attend (DNA) Cancellation Self-deferrals Duty of Care Tertiary Referrals Cons to Cons referrals Patients who are to be admitted as part of a planned sequence of treatment or investigation. The patient has been given a date, or approximate date at the time a decision to admit was made. These patients are not counted as part of the active waiting list Patients who have been informed of their date of admission or preassessment (inpatients/day cases) or appointment date (outpatients) and who without notifying the hospital did not attend for the admission/ outpatient appointment When a patient cancels an appointment (Cancelled by Patient CBP) or the Hospital cancels an appointment (Cancelled by Hospital CBH) Patients who, on receipt of reasonable offer(s) of admission, notify the hospital that they are unable to come in The duty of care rests with the referrer until such time as the referral is accepted by the provider or a Clinical Assessment Service Tertiary Referrals are those referrals between Healthcare professionals from outside of the Trust Are referrals between healthcare profession within the Trust. Patient Access (Waiting List/Waiting Times) Policy v7 26

27 Appendix 1 (cont.) Inter-Provider Transfer Minimum Data Set Form Private Patients Overseas visitors Breach date PTL CCG A form used to accompany patients transferred to Gatehead Health NHS Foundation Trust from another provider showing RTT status Used when patients are referred internally between clinicians identifying continuation of pathway or new condition Private patients who have made separate arrangements to be treated by a practitioner may be charged professional fees by the Consultant / Health Care Professional (OP11a Private Patient Policy) Persons, who are not normally resident in the UK, may be called upon to pay the cost of their hospital treatment unless they meet one of the exemptions from charges (OP11b Treatment of Overseas visitors & Asylum seekers policy) tional.aspx A pathway will become a breach on the day after the breach date if the patient has not received the appropriate appointment/diagnostic test or treatment Patient tracking list Clinical Commission Group Patient Access (Waiting List/Waiting Times) Policy v7 27

28 National Waiting Times Guidelines DSCN 07/2003 Appendix 2 Patient Access (Waiting List/Waiting Times) Policy v7 28

29 National Waiting Times Guidelines DSCN 07/2003 (Page 2) Appendix 2 (cont.d..) Patient Access (Waiting List/Waiting Times) Policy v7 29

30 National Waiting Times Guidelines DSCN 07/2003 (Page 3) Appendix 2 (cont.d..) Patient Access (Waiting List/Waiting Times) Policy v7 30

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