NHS TAYSIDE WAITING TIMES GUIDANCE OPERATIONAL WAITING TIMES DEFINITIONS & BOOKING RULES

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1 Appendix 2 NHS TAYSIDE WAITING TIMES GUIDANCE OPERATIONAL WAITING TIMES DEFINITIONS & BOOKING RULES Policy Manager Kerry Wilson Policy Group Policy Established September 2012 Policy Review Period/Expiry September 2013 Last Updated September 2012 This policy does / does not apply to Medical/Dental Staff (delete as appropriate) UNCONTROLLED WHEN PRINTED 1

2 Guidance Development, Review and Control Policy Version Control Version Number 1.0 Purpose/Change Author Date Updated to reflect changes to National Waiting Times and Operational Procedures K Wilson 1 October

3 Contents Page number 1. Section1 Operational Waiting Times Definitions and Booking Rules Introduction Communication with Patients Patients Waiting Times Calculations Patient Appointments Operational Application of Booking and Recording Patient Waiting Times Clinic Outcomes Operational Guidance (Including Standard Operating Procedures and Booking Script) Section 2 Capacity and Service Planning Consultant/Clinical Staff Leave Planning Notifying Changes to Outpatient Clinical Sessions Notifying Changes to Diagnostic Sessions Notifying Changes to Inpatient & Daycase Sessions 85 2b. Section 2b Templates for Requesting Leave and Changes to Clinical Sessions 86 APPENDIX 1: Procedure for Authorisation and Recording of Annual Leave and CPD Leave for Medical & Dental Consultants 82 (Procedure Embedded in the Main Document) APPENDIX 2: Cancellations/Reductions to Clinical Sessions 86 APPENDIX 3: Outpatient Clinic Cancellation/Reduction Notification 87 APPENDIX 4: TOPAS Clinic Profile Creations 89 APPENDIX 5: TOPAS Clinic Profile Amendment 90 APPENDIX 6: Theatre Session Notification Change Form 91 APPENDIX 7: NHS Tayside Theatre Scheduling Flow Chart 92 3

4 SECTION 1 - OPERATIONAL WAITING TIMES DEFINITIONS & BOOKING RULES 1.1 INTRODUCTION NHS Tayside s Access Policy set out the principles of what NHS Tayside must comply with in relation to waiting times standards and Treatment Time Guarantees as part of the patients legally rights. The waiting times standards and guarantees below operate within and underpin delivery of the 18 weeks referral to treatment standard to support timely access to care for each patient: 12 weeks for new outpatient appointment; 6 weeks for the eight key diagnostic tests and investigations; 12 week for patients eligible under the Treatment Time Guarantee (planned inpatient and daycase treatments). The vast majority of patients will be seen in less than 12 weeks for outpatients and less than 12 weeks for the Treatment Time Guarantee. This section of the Access Policy sets out the operational requirements and procedures that must be applied to ensure that NHS Tayside complies with national policy, legislation and delivery of waiting times standards and guarantees. It also sets out what and how effective and consistent communication with patients will be undertaken in relation to their waiting times guarantees, appointments and waiting times clock adjustments. This includes how: patients waiting times and appointments should be managed and recorded in a consistent way; a reasonable offer of appointment should be made and recorded for patients who access care and treatment; fair and appropriate procedures for communicating with patients and recording information relating to patients who do not or cannot attend, cancel or refuse a reasonable offer of an appointment. 4

5 1.2 COMMUNICATION WITH PATIENTS Communication with patients is essential to ensure that patients and carers where appropriate are provided with clear, accurate and timely information about their access to services and waiting times. It may be necessary to contact the referring clinician or patient/patient s carer to clarify communication requirements such as different formats, languages or interpreter. The patient must be given clear instructions on how and when to contact the hospital to either accept or decline offers of appointments, and the timeframe in which to do this. This can be by telephone, electronically or in writing. All patients must be given clear information on the consequences of not responding quickly to communications and the impact this could have on their waiting time. All patient communication and letters should make sure that the patient can understand their responsibilities and how this might impact on their waiting times. NHS Tayside must advise patients and/or carers in writing when: The patient does not attend an agreed appointment and has not given reasonable notice of this; The patient has been removed from the waiting list, for example, because the patient Did Not Attend or Could Not Attend; or NHS Tayside is unable to meet the waiting times standard. Specific written communication must be provided for patients who are eligible under the Treatment Time Guarantee and also to advise them in writing of any changes or adjustments to their waiting times clock. This is set out below to inform patients: that they are eligible for treatment under the 12 week Treatment Time Guarantee; in the event that they have deemed themselves indefinitely unavailable for treatment; that they have any period of known unavailability for treatment, noting the start and end date of that known period and, where appropriate, noting the anticipated date when the patient will be reviewed; when they have refused two offers of an appointment; when they do not attend an agreed appointment and have not given NHS Tayside reasonable notice of this; when they have accepted a reasonable offer of appointment but then, on three or more occasions cancelled an appointment; that they have been removed from the waiting list, for example, because they Did Not Attend or Could Not Attend; to confirm their request to be treated in a different Health Board; if NHS Tayside is unable to meet the Treatment Time Guarantee; in the event that NHS Tayside has breached the Treatment Time Guarantee, a written explanation of why Treatment Time Guarantee was not delivered. The patient should also be given details of the advice and support available and details of how feedback, comments or complaints can be raised. Any communication which is required in law for the Treatment Time Guarantee is to be made to the patient (or where appropriate the patient s carer) in writing. This may also be electronically if: This has been consented in writing; and Such consent has not been withdrawn in writing In writing includes any communication sent by electronic means if it is received in a form which is legible and capable of being used for subsequent reference. 5

6 1.3 PATIENTS WAITING TIMES CALCULATIONS The patient s waiting time is referred to as a waiting time clock and is calculated based on clock start and end dates and any clock adjustments that must be applied in line with national requirements. The following terms are across all outpatient, inpatient, daycase and diagnostic waiting times. CLOCK START CLOCK ADJUSTMENTS CLOCK STOP This is the date at which the calculation of a patient s waiting time starts. Where it is reasonable and clinically appropriate, the waiting time clock may be adjusted for a number of reasons including: the patient has given NHS Tayside reasonable notice that they cannot attend an appointment; where the patient is unable to attend or did not attend an appointment; when the patient refuses a reasonable offer; periods of time when the patient is unavailable for treatment. This is the date at which the calculation of waiting time stops. The application of patient waiting times clocks for each waiting times standard and guarantee are provided in the sections below Weeks Referral to Treatment NHS Tayside is responsible for ensuring that the patient is treated within 18 weeks from receipt of initial referral to treatment commencing. Clock start this is the date when the referral is received. Clock stop this is the date that treatment commences. Some patient pathways are more complex and the following examples illustrate how the waiting times clock is calculated: LONG TERM CONDITIONS SEQUENTIAL BILATERAL TREATMENT For patients with a long term condition with an exacerbation or recurring symptom, a new waiting time clock must be started for new referrals for the same condition. For patients waiting for a sequential bilateral treatment the waiting time for the second treatment is measured as a separate, second pathway. It may be that the agreement for the need for both treatments is made at the same time. However, normally the agreement to commence the second treatment is only made on or after the post-operative review for the first treatment. The waiting time for the second treatment should not start until that agreement is reached. The sequential treatment must not be managed as a Planned Repeat. 6

7 CONSULTANT TO CONSULTANT REFERRALS PATIENTS TRANSFERRED TO A PLANNED SERVICE VIA ACCIDENT & EMERGENCY, MINOR INJURY UNIT OR WALK- IN CENTRE PATIENTS WHO SELF REFER For consultant to consultant referrals a new waiting times clock will be started on receipt of the referral by the new consultant-led service if the referral is for a new condition only. If the consultant to consultant referral relates to the same condition that the patient was initially referred for, then the existing clock will continue and a new clock should not be started. For patients transferred to a planned service via Accident & Emergency, Minor Injury Unit or Walk-in centre a formal referral will not always be sent. The waiting times clock will start on the date of attendance to A&E/Minor Injury Unit/Walk-in Centre where the purpose of the appointment is for treatment, not a follow-up to treatment already started in A&E/Minor Injury Unit/Walk-in Centre. For patients that self refer the waiting time clock starts on the date that the patient self-refers New Outpatients NHS Tayside is responsible for ensuring that patients are seen for their outpatient appointment within 12 weeks from the date of receipt of referral. The waiting times clock for outpatients is described below: Clock start this is the date the referral is received Clock stop is the date of the new outpatient appointment LONG TERM CONDITIONS CONSULTANT TO CONSULTANT REFERRALS PATIENTS TRANSFERRED TO A PLANNED SERVICE VIA ACCIDENT & EMERGENCY, MINOR INJURY UNIT OR WALK- IN CENTRE PATIENTS WHO SELF REFER For patients with a long term condition with an exacerbation or recurring symptom, a new waiting time clock must be started for new referrals for the same condition. For consultant to consultant referrals a new waiting times clock will be started on receipt of the referral by the new consultant-led service if the referral is for a new condition. For patients transferred to a planned service via Accident & Emergency, Minor Injury Unit or Walk-in centre a formal referral will not always be sent. The waiting times clock will start on the date of attendance to A&E/Minor Injury Unit/Walk-in Centre where the purpose of the appointment is for treatment, not a follow-up to treatment already started in A&E/Minor Injury Unit/Walk-in Centre. For patients that self refer the waiting time clock starts on the date that the patient self-refers. 7

8 1.3.3 Treatment Time Guarantee NHS Tayside is required in law to ensure that patients access their treatment within 12 weeks. The clock start and stop dates are clarified below. The Clock start for the Treatment Time Guarantee is the date when the clinician and patient agree to the agreed treatment (which will be the date when the decision is made by the clinician to put the patient on the waiting list). CLOCK START For the vast majority of patients agreement will be the date of the outpatient appointment. It is therefore essential there is no delay between the agreement to treat and the patients waiting time clock starting. However, before the treatment can be agreed, some patients may be required to undergo a diagnostic test. The patient will be contacted about the test result, normally by phone or at a return outpatient appointment. In such cases, the treatment would be agreed at that time, which would be the start date of the Treatment Time Guarantee. The Clock stop for the Treatment Time Guarantee is the date that the patient starts to receive the agreed treatment. CLOCK STOP Normally, the patient will be admitted to hospital on the day of treatment, and the treatment time end point will be recorded as such. The patient may be admitted for treatment the day before their actual surgery. Where this occurs in order to start to the initial stages of treatment, for example, to administer medication or to clinically prepare the patient, this date should be recorded as the end date i.e. the start of treatment. The information below provides some further detail which should be understood in relation to the treatment time guarantee: Should the patient indicate they would like to have time to consider whether to go ahead with the treatment, then the calculation of the Treatment Time Guarantee will not start until the patient agrees to proceed with that treatment. Good practice is to ascertain from the patient how long they wish to take to consider the treatment and agree a date when the hospital will contact them to discuss this further and agree treatment. In such circumstances the contact date should be noted and the patient should be contacted on that date. If the patient agrees the treatment at that point, then that is the start of the clock start date for the Treatment Time Guarantee. Should the patient wish for more time to consider the treatment, then good practice would be for a discussion to be held with the appropriate clinician to determine if a further contact date should be agreed, or if the patient should be referred back to the GP (i.e. the referring clinician). Pre-operative assessment cannot be taken as the date of agreement to treatment as the clinician and the patient will have previously already agreed to the agreed treatment. The pre-operative assessment appointment is intended to ensure that the patient is fit for treatment which has already been agreed, and does not constitute agreeing to treatment. The start date, based on agreement to treat, is clear in legislation and this must be applied at all times. 8

9 Some further examples of patient pathways and waiting times clocks under the Treatment Time Guarantee are provided below: ONE-STOP SERVICE SEQUENTIAL BILATERAL TREATMENT For Referral to a One-Stop Service for patients seen on an inpatient or day case basis the date the patient agrees treatment and the date of the treatment will be the same, and the patient will have a zero-wait recorded against the Treatment Time Guarantee. For the small number of patients where treatment can not be undertaken on the day, the waiting time clock will continue. For Patients waiting for sequential bilateral treatment the waiting time for the second treatment is measured as a separate, second pathway. It may be that the agreement for the need for both the treatments is made at same time. However, normally the agreement to commence the second treatment is only made on or after the post-operative review for the first treatment. The waiting time for the second treatment should not start until the clinician and patient agree to the agreed treatment. The sequential treatment must not be managed as a Planned Repeat. PATIENTS TRANSFERRED TO A PLANNED SERVICE For patients transferred to a planned service via Accident & Emergency, Minor Injury Unit or Walk-in centre a formal referral will not always be sent. The waiting times clock will start on the date when the clinician and patient agree to the agreed treatment. PATIENTS WHO TRANSFER TO ANOTHER HEALTH BOARD AREA For patients changing their ordinary resident to another Health Board area whose waiting time clock has already been started and that patient requests to be treated within that other Health Board area (i.e. the Health Board of their new residence) the new responsible Health Board may reset the calculation of waiting time to zero where that is reasonable and clinically appropriate to do so. A suspension of the Treatment Time Guarantee will only be granted by Scottish Ministers in very exceptional circumstances for a period of up to 30 days. A longer period will require approval in the Scottish Parliament. Scottish Government Health Directorate processes should be followed when seeking a suspension. 9

10 1.3.4 Eight Key Diagnostic Tests and Investigations Timely access to diagnostic tests and investigations support early diagnosis of a patient s condition, and support a decision on their clinical pathway, care or treatment. The waiting times standard for the 8 key diagnostic tests below is 6 weeks. NHS Tayside has to ensure that the diagnostic test and verified report is received by or made available to the requester within 6 weeks. These tests included within this standard are: Upper Endoscopy; Computer Tomography (CT); Lower Endoscopy (excluding Colonoscopy); Magnetic Resonance Imaging (MRI); Colonoscopy; Barium Studies; Cystoscopy; Non-obstetrics Ultrasound The clock start and stop for these diagnostic tests are: CLOCK START CLOCK STOP This is the date when the request for the test or procedure is received within the department. is the date the verified report has been received or made available to the requester. Some patient pathways are for diagnostic test only and some diagnostics can be part of an 18 weeks or outpatient pathway. When a request for a diagnostic test only is made, this is referred to as DIRECT ACCESS. This is defined as: any service or part of a diagnostic service where a patient is referred without having been seen directly by a medical consultant or referred to a pathway under the auspices of a medical consultant. Some patient pathways that include diagnostic tests prior to being seen by secondary care service are referred to a STRAIGHT TO TEST and are part of a referral pathway. This is defined as: any service, or part of a diagnostic service, e.g. endoscopy where a patient is referred into secondary care under the auspices of a medical consultant or pathway, but is triaged for a diagnostic investigation without having been first seen directly by a medical professions. This patient waiting time clock commences on receipt of referral to secondary care as this is defined as being the start of a new outpatient and 18 weeks clock. The diagnostic test and the outpatient appointments must to be within 12 weeks of receipt of referral. 10

11 1.4 PATIENT APPOINTMENTS Principles of Reasonable Offer of Appointments This section set out the principles and good practice in booking and recording reasonable patient appointments. A reasonable offer of appointment is the offer of two dates of appointment for each stage of the patient s pathway. Patients should be given a minimum of seven days notice from the date of each offer of appointment to the date of the appointment. NHS Tayside must ensure that patient additional needs are taken into account and that appropriate support is put in place as required when offering an appointment date. Offers of Appointment Accepting a Reasonable Offer Short Notice Appointment Dates When Making a Reasonable Offer In Offering Appointment Dates by Letter Urgent Appointments Treatment Time Guarantee Appointments Offers should be made as soon as possible after receipt of referral or when the clinician and the patient agree to the agreed treatment. If the patient accepts the first appointment date offered then this will be deemed as accepting a reasonable offer of appointment and a further date need not be offered. (i.e. those offered with less than seven days notice) can be offered. If the patient accepts such an offer, then this would be deemed to be a reasonable offer of appointment. However, if the patient declines such a short notice offer, they must not be disadvantaged, and must be made a reasonable offer for a further two or more different dates of appointment within the waiting time standards and Treatment Time Guarantee. Clearly cases of clinical urgency will require an alternative appointment. it is good practice for appointment offers to be made as soon as possible after the patient agrees treatment, and ideally at least fourteen days before the proposed treatment date. (The minimum period of notice for a reasonable offer of appointment is seven days). the patient should receive the letter at least fourteen days prior to the appointment date. The letter should be in a format appropriate to the patient s needs and should clearly set out details of how the patient can request an alternative date and a reasonable timescale to do so. where the waiting time should be determined by clinical need, are excluded from the reasonable offer timescale of seven days notice. However, every effort should be taken to agree a date suitable for the patient taking account of the urgency and availability of clinical services. appointments must be offered within the Treatment Time Guarantee or the waiting time standard which applies to each patient for that part of the journey. If the patient has not been seen within waiting times standard or Treatment Time Guarantee this must be clearly reported as exceeding waiting time standard or Treatment Time Guarantee (taking account of periods where the waiting time clock has been adjusted. The specific requirements of how this should be recorded in TOPAS are set out in Standard Operating Procedure 8 Commencing Treatment Time Guarantee 11

12 Breaching Treatment Time Guarantee the patient should be offered the next available appointment having regard to the patient s availability and other relevant factors. It is also important that the patient is provided with an explanation in writing of why the Health Board did not deliver the Treatment Time Guarantee, details of the advice and support available and details of how feedback, comments or complaints can be raised. In arranging the next available appointment, NHS Tayside must not prioritise the start of the patient s treatment if that would be detrimental to another patient with a greater clinical need for treatment. The specific requirements of how this should be recorded in TOPAS are set out in Standard Operating Procedure 9 Breaching Treatment Time Guarantee Implied Acceptance Appointment Location where the process of Implied Acceptance is used, the patient s waiting times clock must not be adjusted if they do not attend the offered first appointment date because they have not yet accepted a reasonable offer of two or more different dates of appointment. (national clarification awaited) It is not considered a reasonable offer of appointment if the patient is offered a treatment location without an offer of date for appointment. It is expected that most patients will be seen and treated locally wherever possible and appropriate, based on clinical need and operational effectiveness. However, it may not always be possible for NHS Tayside to provide access locally for all patients and for all services. Possible and reasonable service locations should also be explained to each patient from the outset. It is a reasonable offer where for NHS Tayside to offer the patient an appointment at any of the following locations: Any site within the NHS Tayside area providing the required service, unless specified in the Local Access Policy arrangements for remote and rural settings. Any site out with the NHS Tayside area where treatment is routinely provided i.e. a national or regional service centre. In certain circumstances, limited use of alternative providers, within or without the NHS Tayside area, including Independent Sector providers, may be required in response to capacity constraints and would also constitute a reasonable offer. When NHS Tayside is unable to meet the waiting time standards or Treatment Time Guarantee within its own area and has arranged for treatment by another suitable alternative provider out with the area, NHS Tayside is responsible for the cost of any transport and accommodation arrangements necessarily and reasonably incurred by the patient and their carer (if necessary). This would not apply, however, if the patient has requested to be treated elsewhere for personal reasons. It is important that patients are advised as early as possible of the likely need to travel for treatment. If an offer is to be made for treatment out of the NHS Tayside area, or at a location not listed in the Local Access 12

13 Policy, then the provision of clear and accurate communication to patients is essential; NHS Tayside has set out a good practice approach and script for staff s use in these circumstances. As part of this, it is helpful to record the willingness to travel of patients at the start of the process. A small number of patients may wish to request a specific appointment location. Accommodating a request for a specific appointment location cannot be guaranteed in any case. Where the patient would prefer to wait for treatment at a specific location, rather than receive treatment at another location, and NHS Tayside does agree to accommodate this request, the patient s wait might be longer than the waiting time standards or Treatment Time Guarantee. The patient should be made aware of the length of the wait they will experience in writing. It must be clear that this is at the patient s request and that they are fully aware of the consequences. A request for treatment in a specific location cannot be prompted by NHS Tayside. Named Consultant Patients are referred to a clinical team and seen by an appropriate member of that team rather than to an individual consultant. This Access Policy sets out that a reasonable offer of appointment relates to any competent clinician who is part of the consultant-let service which the Health Board provides in that speciality or subspecialty. A named consultant will only be allocated to ensure continuity of care, patient safety or for other clinical or exceptional reasons. A small number of patients may wish to request a named consultant. Accommodating a request for a specific named consultant cannot be guaranteed in any case. Where the patient would prefer to wait for an appointment with a named consultant, rather than an appointment with another consultant, and NHS Tayside agrees to accommodate this request, the patient s wait might be longer than the waiting time standards or Treatment Time Guarantee. The patient should be made aware of the length of the wait they will experience in writing. It must be clear that this is at the patient s request and that they are fully aware of the consequences of their decision. A request for an appointment with a named consultant cannot be prompted by NHS Tayside. Patient Refuses a Reasonable Of if the patient refuses a reasonable offer (i.e. two different dates of appointment), then advice on next steps should be sought from the relevant clinical team to decide whether the patient: should be referred the patient back to their referring clinician; treatment time clock is reset to zero if it is not reasonable and clinically appropriate to refer the patient back to their referring clinician. A period of unavailability must not be applied in circumstances when the patient refuses a reasonable offer of appointment. NHS Tayside must inform patients of the consequences of refusing a reasonable offer of appointment. Also, for patient under the Treatment Time Guarantee, if the patient is referred back to their referring clinician, NHS Tayside must write to the patient, the patient s referring clinician and, 13

14 where appropriate, the patient s carer to inform them of this. It is important that the date the patient declined the reasonable offer is recorded and the actions taken i.e. refer back to referring clinician or reset the waiting time clock to zero. The patient s waiting clock is reset to zero from the date on which the last offer was declined, not the date of the offered appointment. Offers of Appointment Beyond the Treatment Time Guarantee When NHS Tayside has not complied with the Treatment Time Guarantee, NHS Tayside must make such arrangements as are necessary to ensure that the agreed treatment starts at the next available opportunity, having regard to the patient s availability and other relevant factors. However, this prioritisation to the start of treatment must not be to the detriment of another patient with a greater clinical need for treatment. Short notice appointment dates can be offered. If the patient declines such a short notice offer, they should be offered the next available appointment for treatment. If the patient refuses this offer, then the patient should be offered the next available appointment without resetting the waiting time clock to zero. NHS Tayside must provide the patient with an explanation why their Treatment Time Guarantee did not start within 12 weeks. The patient must be given details of the advice and support service available and how to give feedback, comments or raise concerns. 14

15 1.5 OPERATIONAL APPLICATION OF BOOKING AND RECORDING PATIENT WAITING TIMES This Section sets out the specific actions that must be taken be all staff who process patient referrals, appointments and apply and waiting time clock rules and adjustments. This is laid out following the patient journey for ease of reference. These are standard operating procedures and scripts that all staff should follow. These are referred to in the sections below and are provided in Section 4b of this policy Patient Referral The majority of patient referrals are received through SCI Gateway and screened by secondary care clinicians who confirm whether any diagnostic tests are required prior to booking the outpatient appointment or confirm which clinic the patient should attend. A small amount of referrals are received in paper format and from clinician to clinician, Standard Operating Procedure No 1 provides details of how to record and process any referral information through the TOPAS system including onward referrals from other NHS Health Boards Booking Patient Appointments and Application of Reasonable Offers Regardless of the method of offering patients appointments, patients should be offered a reasonable offer of appointment as outlined in section above. The methods of booking in NHS Tayside are patient focussed booking and direct booking which is in line with the nationally recommended effective patient booking. PATIENT FOCUSSED BOOKING Following referral screening, patients are sent a letter inviting them to contact the booking team to agree a reasonable appointment date. The patient should be allowed at least seven days from the date the letter is sent to respond to the initial invite to contact the hospital. If no contact has been made after this time a clock pause commences and a reminder letter should be sent to the patient. The clock pause ends when the patient contacts the hospital to arrange a suitable date. Standard Operating Procedure No 2 Patient Focussed Booking - provides the specific detail of how this process should be followed and patient details recorded within TOPAS and a script for discussing appointments with patients. DIRECT BOOKING This is where the patient is sent a notification of an appointment directly by post. The patient is asked to contact the booking team to confirm that this date is suitable for them to attend. If they do not contact the hospital within 7 days of send the appointment letter it is referred to as implied acceptance of a reasonable offer. (this is to be confirmed if this applies to TTG patients and OP s) Standard Operating Procedure No 3 - Direct Booking provides the specific details of how this process should be complied with. 15

16 1.5.3 Application of Patient Unavailability There are only two reasons why a patient may be recorded as unavailable for treatment, - medical reasons or patient-advised reasons: These are the only circumstances where unavailability may be applied. A registered medical practitioner has advised that the patient has another medical condition which prevents the agreed treatment from proceeding, or Because the patient has advised the Health Board that they are unavailable for treatment. The application of patient advised unavailability can only be made at the request of the patient. Where the patient is unavailable for treatment, this will have an impact on the calculation of waiting time. This period of time is not included in the patient s waiting time. Patients may be unavailable for a known period of time or they could be indefinitely unavailable. NHS Tayside must provide patients with clear and accurate information about how their waiting time is calculated and must record clear and accurate information about the reason for the patient s waiting time unavailability. The reasons for patient unavailability are set up to ensure that mandatory recording of patient unavailability is in line with national requirements. Standard Operating Procedures 4 Applying Known Medical Unavailability and Applying Known Patient Advised Unavailability sets out the specific requirements for communication with patients and recording unavailability. These SOP s include how to record indefinite unavailability, NHS Tayside must advise Treatment Time Guarantee patients in writing when they have been deemed indefinitely unavailable for treatment or when they are unavailable for treatment for a known period, noting the start and end date of that known period and, where appropriate, noting the anticipated date when the patient will be reviewed. The Health Board must also inform the patient of how this will affect their Treatment Time Guarantee clock. In the event that NHS Tayside does not comply with the Treatment Time Guarantee it must make arrangements to ensure that the agreed treatment starts at the next available opportunity, taking account of the patient s availability. If the patient is unavailable for a known period they should be offered the first available appointment following their period of unavailability. However, this must not be to the detriment of another patient with a greater clinical need for treatment. KNOWN UNAVAILABILITY MEDICAL UNAVAILABILITY Known unavailability is a period of time when it is known that the patient would not be in a position to accept an offer of appointment due to medical or patient advised reasons. This is when the patient is unavailable for the appointment or treatment for a known period of time because a registered medical practitioner has advised that the patient has another medical condition which prevents the agreed appointment or treatment from proceeding for that period of time. Medical unavailability may only be applied by a clinician working under a protocol as part of a consultant lead service. In relation to the Treatment Time Guarantee, medical unavailability can only be applied because a registered medical practitioner has advised that the patient has another medical condition that prevents the agreed treatment from proceeding. 16

17 Start Date of the period of unavailability is the date the registered medical practitioner / clinician made the decision that the patient was medically unavailable. End Date of the period of unavailability is the date when the registered medical practitioner / clinician decides the patient is now fit to undergo their treatment. Medical unavailability relates to the patient and should not be used to describe unavailability of the clinical service. Standard Operating Procedure 4 Applying Medical Unavailability- provides explicit rules around how medical unavailability should be recorded within TOPAS. This is when the patient is unavailable for the appointment or treatment for a known period of time and must only be applied when the patient has advised that they are unavailable for the appointment or treatment for that known period. NHS Tayside must not estimate any period of patient advised unavailability. When a patient advises that they have a period of unavailability, they should be asked to clarify when the period of unavailability should start and end. Start Date of the period of unavailability is the date when the patient has advised the period of unavailability will start. End Date of the period of unavailability will be the date when the patient has advised the period of unavailability will stop. PATIENT ADVISED UNAVAILABILITY National clarification of what can be recorded as patient advised unavailability is provided below: Patient Advised - on holiday Patient Advised - personal commitment Patient Advised - work commitment Patient Advised - Carer commitment Patient Advised - academic commitment Patient Advised - Jury Duty Application of patient advised unavailability should be recorded once the patient has advised of their unavailability A start and end date should be recorded. Patient Advised wishes named Consultant Patient Advised wishes specific Location 17

18 1.5.4 Patient Advised - wishes named Consultant Clinical services in NHS Tayside are provided mainly by a clinical team rather patients being referred to or treated by an individual consultant. Booking processes are aligned to offer patients the next available appointment with that clinical team. However, a small number of patients may wish to request a named consultant even though that may make the waiting time longer than the waiting time standards or Treatment Time Guarantee. This should not be the norm but where the patient does prefer to wait, for a specific consultant, resulting in a waiting time longer than the waiting time standards or Treatment Time Guarantee, then the patient may request for a period of unavailability to be applied. The patient must be made fully aware of the implications of their request on the length of wait they will experience. It must be made clear that this is at the patient s request and that they are fully aware of the impact of their decision. That is, it is the patient s choosing to wait longer than the waiting times standards or Treatment Time Guarantee in order to have the appointment with a specific consultant and this cannot be prompted by the Health Board. The application of patient requested unavailability in this case would be used only when it is clear that the delay would be time limited and the offer of appointment or treatment by the named consultant could be made within a specified period of time. Start Date of the period of unavailability will be the date when the patient has advised that they wish to be seen by a specific consultant. End date of the period of unavailability will be the date of the appointment Patient Advised wishes specific location NHS Tayside s Access Policy details the locations where the appointment or treatment may reasonably be undertaken (including planned capacity outwith the Health Board area, and in some instances, the Independent Sector). A small number of patients may, however, wish to request a specific location even though that may make the waiting time longer than the waiting time standards or Treatment Time Guarantee. This would be unusual and one would not expect large numbers of patients to request treatment at a particular location. Accommodating a request for a specific location of appointment or treatment cannot be guaranteed in any case. Where the patient does prefer to wait locally for an appointment or treatment, resulting in a waiting time longer than the waiting time standards or Treatment Time Guarantee, then the patient may request for a period of unavailability to be applied. It must be made clear that this is at the patient s request and that they are fully aware of their decision. That is, it is the patient s choosing to wait longer than the waiting times standards or Treatment Time Guarantee in order to have the appointment or treatment in a specific location and this cannot be prompted by the Health Board. The application of patient advised unavailability in this case would be used only when it is clear that the delay would be time limited and the offer of appointment or treatment at the requested location could be made within a specified period of time. The application of patient advised unavailability can only be made at the request of the patient and must not be prompted by the Health Board. 18

19 Start Date of the period of unavailability will be the date when the patient has advised that they wish to be seen at a specific location. End date of the period of unavailability will be the date of the appointment. The application of patient requested unavailability can only be made at the request of the patient and must not be prompted by the Health Board. Patient Advised Visiting Consultant Service patient wishes to be seen at next scheduled service within Board of residence Patient Advised following severe weather cancellation of Visiting Consultant Service, wishes to be treated within local Health Board The definitions of how this is to be applied and recorded are part of the national discussions regarding the reference file dataset. Standard Operating Procedure 4 Applying Patient Advised Unavailability set out the requirements for staff to follow Indefinite Unavailability Indefinite unavailability is when the likely period of unavailability (whether that be for medical or patient advised reasons) cannot be determined. Before Treatment Agreed - If treatment has not been agreed between the patient and an NHS Tayside Clinician, and the patient is indefinitely unavailable for such a treatment, the waiting times clock will not start. Patients should not be added to the waiting list if there is no known end date to their unavailability. Clinical staff should advise the patient that they have been deemed indefinitely unavailable and the date when they will be reviewed. After Treatment Agreed - the patient may become indefinitely unavailable once the waiting times clock has already started. In such a case, the waiting times clock will stop and the waiting time standards or Treatment Time Guarantee cease to apply to that patient. If the patient is then deemed to be available after a period of indefinite unavailability, then a new waiting time standards clock starts from zero from the date that the patient becomes available. A new Treatment Time Guarantee clock starts from zero from the date that the clinician and the patient agree to the agreed treatment. Patient indefinite unavailability must be reviewed within 12 weeks from the date the patient became unavailable for treatment. The outcome of this review should be recorded. If the patient is still indefinitely unavailable following such a review, a second review must be undertaken within 12 weeks of the date of the first review. If, following the second review the patient is still indefinitely unavailable, the patient must be referred back to the referring clinician. If the patient is then deemed to be available after the second review, then a new waiting time standards clock starts from zero from the date of the review. A new Treatment Time Guarantee clock starts from zero from the date that the clinician and the patient agree to the agreed treatment. 19

20 In all circumstances the start date, reason and review dates and outcomes for indefinite unavailability should be record. Standard Operating Procedures 4 includes how to applying and record indefinite unavailability Non Attendance & Changes to Patient Appointments and Treatment Patients who Could Not Attend Appointment of Treatment The specific requirements of how this should be recorded in TOPAS are set out in Standard Operating Procedure 5 Changes to Patient Appointments. If the patient has accepted a reasonable offer of appointment but then gives the hospital reasonable notice that they will not be able to attend that appointment (CNA), then advice on next steps should be sought from the relevant clinical team. The patient s waiting times clock, may be reset to zero where it is reasonable and clinically appropriate to do so. This would be effective from the day that the patient advises that they can not attend. Should a patient requiring an urgent appointment or treatment cancel an agreed appointment (giving reasonable notice to the Health Board), the patient should be offered another appointment within the waiting time standards or Treatment Time Guarantee without resetting the clock to zero. When the patient advises that they have a minor illness such as cold, which may prevent them from attending the appointment on the agreed date, clinical advice must be sought as to the clinically appropriate course of action. If the clinician has advised that the patient s minor illness will prevent the agreed appointment or treatment from proceeding on the agreed date, a known period of medical unavailability should be applied, This would normally be for a short period only, for example, up to two weeks. If the clinician has advised that the patient s minor illness will not prevent the agreed appointment or treatment from proceeding on the agreed date, the appointment should go ahead as planned. If the clinician has advised that the minor illness will not prevent the agreed appointment or treatment from proceeding on the agreed date but the patient can not attend (CNA) the agreed appointment, the patient s waiting time clock is reset to zero, where it is reasonable and clinically appropriate to do so. If the patient cancels an agreed appointment for the third time then the patient would normally be referred back to their referring clinician, where it is reasonable and clinically appropriate to do so. The waiting time standards and Treatment Time Guarantee will cease to apply. If it is not reasonable or clinically appropriate to refer the patient back to their referring clinician, then the clock may be reset to zero and the patient offered a further appointment. The clock should be reset to zero from the date the patient advised they were cancelling their agreed appointment. If the patient is to be referred back to their referring clinician, then clinical advice must be sought to confirm it is appropriate and clinically reasonable to do so. The date of the decision to refer the patient back to their referring clinician in the patient s health record and must also be recorded on the patient administration system. 20

21 Patients (or where appropriate the patient s carer) must be advised of the consequences of cancelling an agreed appointment and how this affects their waiting time clock. The patient s referring clinician should also be advised when the patient has been removed from the waiting list. In the event that NHS Tayside has not complied with the Treatment Time Guarantee it must make arrangements as are necessary to ensure that the agreed treatment starts at the next available opportunity, having regard to the patient s availability and other relevant factors. If the patient cancels an agreed appointment, then the patient should be offered the next available appointment without resetting the clock to zero. However, this prioritisation to the start of treatment must not be to the detriment of another patient with a greater clinical need for treatment Did Not Attend The specific requirements of how this should be recorded in TOPAS are set out in Standard Operating Procedure 6 Patient NON- Attendance for appointments and Treatment If the patient does not attend an agreed appointment or treatment date or does not given reasonable notice that they are not able to attend (e.g. if the patient cancels on the day of appointment this should be recorded as a DNA as the appointment could not be offered to another patient) then advice on next steps should be sought from the clinical team to which the patient was referred. The patient s waiting time clock should be reset to zero or the patient referred back to their referring clinician, where it is reasonable and clinically appropriate to do so. The waiting time standards and Treatment Time Guarantee will cease to apply where the patient is referred back to their referring clinician. Should a patient requiring an urgent appointment or treatment not attend an agreed appointment, the patient should be offered another appointment within the waiting time standards or Treatment Time Guarantee without resetting the clock to zero. The date of the patient s non attendance must be recorded. If the patient is being referred back to their referring clinician, the reason for this should be recorded by the clinician in the health records. This should include why this was reasonable and clinically appropriate. This should also be recorded in the patient administration system. Patients must be advised of the consequences of not attending an agreed appointment. Also, for patients under the Treatment Time Guarantee, if they are referred back to their referring clinician the letter should be sent to the patient, the patient s referring clinician, and where appropriate the patient s carer to inform them of this. Out-Patient referrals can be re-activated by contacting the outpatient service within a 4 week period. The letter to the patient should inform them that the referral will remain on file for 4 weeks and can be re-activated during that time. If the patient or referrer has not contacted the service within this period the patient will remain as discharged. If a referrer contacts the hospital for another appointment after this 4 weeks period, this should be treated as a new referral as per date of telephone call/letter. In the event that NHS Tayside has not complied with the Treatment Time Guarantee, arrangements should be made to ensure that the patient s agreed treatment starts at the next available opportunity. If the patient does not attend an agreed appointment and has not given reasonable notice of this, then the patient should be offered the next available appointment without resetting the clock to zero. However, this prioritisation to the start of treatment must not be to the detriment of another patient with a greater clinical need for treatment. 21

22 Could Not Wait There may be occasions where the patient has registered their arrival for an appointment but cannot wait to be seen. What should be recorded will vary dependent on whether it is a patient- or serviceinduced situation. If the delay is caused by the late running of an appointment and that delay is much longer than the patient could reasonably be expected to wait (e.g. more than 30 minutes), then this should be recorded as Could not Wait Reasonable). The patient given another reasonable offer of appointment within the waiting time standards and Treatment Time Guarantee. If there is a minor delay in the time the patient waits after their appointment time (e.g.less than 30 minutes) provided that the patient has been given information on the delay, but the patient is not willing to wait even a short length of time, then the outcome should recorded as a Could not Wait Unreasonable The patient should be made another reasonable offer of appointment but because it was unreasonable for them not to wait, their waiting time clock will be reset to zero, where it is reasonable and clinically appropriate to do so. It is important that patients are advised, prior to attending their appointment, of the expected duration of their attendance. If the appointment is planned to consist of more than one consultation, the patient should be recorded as a Cound not Wait Unreasonable if the patient is not willing to wait for all consultations within the appointment. The patient should be made another reasonable offer of appointment but because this is a CNW, the patient s waiting time clock would be reset to zero, where it is reasonable and clinically appropriate to do so. Standard Operating Procedure 7 Patients who Could Not Wait sets out the specific requirements for discussing this with the patient recording in TOPAS Cancelled by Service (see Standard Operating Procedure 5) Patients must not be disadvantaged as a result of changes such as cancellations resulting from operational circumstances. Should this occur, the patient s waiting time clock should continue ticking and the patient should be made a further reasonable offer as soon as possible and within the waiting time standards and Treatment Time Guarantee. If, having been admitted, a planned treatment is unexpectedly cancelled; the patient cannot be recorded as having started treatment. The patient must still undergo treatment within the waiting time standards and Treatment Time Guarantee. 22

23 1.6 CLINIC OUTCOMES Week Outcome Sheets An 18 Week RTT Outcome Sheet is generated for all outpatients. It is the responsibility of the clinician who sees the patient to ensure that this Outcome Sheet is correctly filled in. Clinicians are expected to tick only one box from the appropriate section. Each option links to a specific clock stop, continue or reset outcome that ensures the patient journey can be tracked and that each patient receives quicker treatment. Stopping the clock is a clinical decision and this is key to the overall measurement of 18 week pathways and recording of clinical activity. Once the Outcome Sheet has been completed and all necessary information noted, the outcome should be recorded on Topas. If a procedure has been carried out then the appropriate procedure should be ticked on the Procedure List which will be attached to the Outcome Sheet. The Outcome Sheets and Procedure Lists will be specific to each specialty. The procedure will then be recorded in Topas Week Clock The following 18 Week Outcomes will stop the clock: The following 18 Week Outcomes will continue the clock: The following 18 Week Outcomes will reset the clock: Discharged: Patient seen and discharged Treatment commenced (no procedure) with or without follow up appointment Treatment commenced (with procedure) with or without follow up appointment Review: Active monitoring with open appointment, or with follow up appointment Did Not Attend: Discharged back to GP Test/Investigations: Requested/awaiting test results with or without follow up appointment Add to Waiting List: For Inpatient, Day Case or Outpatient procedure Onward Referrals for Same Condition: To other clinician/specialty, for therapy or to other health board. The onward referral has to be for the same condition. Could not Wait (Reasonable): The patient could not wait and the time period was classed as reasonable. Did Not Attend: Further appointment to be given the patients clock will reset to zero from the date of the DNA appointment. Could Not Wait (Unreasonable): The patient could not wait and the time period was called as unreasonable the patient s clock would be reset to zero. Did Not Attend: Further appointment to be given the patients clock will reset to zero from the date of the DNA appointment. Could Not Wait (Unreasonable): The patient could not wait and the time period was called as unreasonable the patient s clock would be reset to zero. 23

24 1.6.3 Monitoring Missing Outcomes Clinical staff are responsible for ensuring that outcomes are recorded on the Outcome Sheet, or put directly into Topas, at time of clinic. All specialties/services should have processes in place to ensure that a Missing Outcome Report (available via Topas) is run on a weekly basis and the necessary steps taken to ensure that all missing outcomes are completed. Failure to complete missing outcomes results in the following: Activity not being recorded locally or nationally Any outpatient procedures carried out will not be recorded locally or nationally which will impact on NHS Tayside s performance figures. 18 Week Referral to Treatment clock still ticking and causing patients to breach treatment times. 24

25 1.7 NHS Tayside Waiting Times Guidance for Applying Access Policy October 2012 Please note: It is possible for patients to be guaranteed by one, two, three or four of these waiting times standards dependent on their journey 25

26 1.7.1 STANDARD OPERATING PROCEDURE 1 STANDARD OPERATING PROCEDURE FOR TOPAS REFERRAL PROCESSES SOP NUMBER: VERSION NUMBER: 4 PREVIOUS VERSIONS: 3 EFFECTIVE DATE: 15/11/2011 REVIEW DATE: AUTHOR: Linda Fox/Heather Anderson Referral Governance Project Manager, Referral Governance Manager APPROVED BY (1): Linda Fox Referral Governance Manager DATE APPROVED: APPROVED BY (2): Kerry Wilson Access Service Manager (Health Records & Improvement Programmes) DATE APPROVED: 26

27 DOCUMENT HISTORY Version Edited by (job title): Number: 1 Referral Governance Project Manager 2 Referral Governance Project Manager 3 Referral Governance Manager 4 Referral Governance Manager 5 Referral Governance Manager 6 Referral Governance Manager 7 Referral Governance Manager Effective Date: Details of editions made: Screenshots added Minor changes & timescales added 15/11/2011 Updates and minor changer Screenshots updated. Update of RMS/Topas information link and the change to recording of referring GP in the Source in Topas June 2012 Update of RMS/Topas information link and the change to recording of test to book 10/09/2012 Update of SCI-Gateway/RMS information for recording of screening information not prepopulated through link 10/09/2012 Update of SCI-Gateway/RMS information for recording of Unavailability 27

28 1. PURPOSE The purpose of this standard operating procedure is to provide guidance around the recording of patient referral information in Topas - promoting good practice and hopefully achieving consistency of service. 2. APPLICABILITY This SOP applies to any staff member who inputs out-patient referral information into Topas and the processes around this. 3. PROCEDURE The Process for referral by General Practice is through the national referring tool, SCI-Gateway, which is available throughout Scotland. Once a referral is sent to the Tayside instance of SCI-Gateway, this links into the local Referral Management Service, and allows clinical screening to be undertaken. Once a referral is clinically screened, or accepted without screening, the referral information, with validation of patient details (name, address, CHI &GP), will transfer automatically into the Topas patient referral screen. 28

29 The requested information from General Practice; preferred clinician (if appropriate), specialty, priority, location, and referring GP and registered GP will also populate. The allocated clinical screening information e.g., preferred clinician (if appropriate), specialty, priority and location The clinical booking, cancellation, redirection information and reasons will also pass automatically from RMS to Topas, The subspecialty, clinical instructions (this is directed at General Practice) and any additional information/instructions to allow Medical Records to appoint appropriately will also auto-populate. Referral information not populated should be input manually, this includes the screening information provided by clinical staff. 29

30 TOPAS FAILURES The referral will only automatically transfer to Topas if the validation process has been completed. In the event that the validation process is not completed this will be referred to as a failure. Examples of a failure could be mis-match of name, address, GP. 30

31 To ensure robust evaluation and monitoring of the automated process, the Topas referral failures will be initially managed centrally by Medical Records Departments across Tayside. All anomalies will be recorded in the RMS location for the referral site e.g. Ninewells Hospital. Staff in Medical Records will have access to each individual Electronic Referral Service Administrator module per location, and will deal with anomalies within this, updating Topas of the change and resubmitting the information. Any system failures will be reported to and and will be taken forward with the Development Team. If a system failure takes longer than 24 hours to correct, the referral information will be manually pushed to the Print queue to ensure no delays. Any failures in the system will generate a group daily (6am) to inform staff of the failures. The following areas have been identified to deal with the anomalies: Medical Records Ninewells Hospital All referral anomalies Dundee, Perth and Angus (except Mental Health) Medical Records Carseview Hospital All Mental Health referral anomalies Dundee area Medical Records Murray Royal Infirmary All Mental Health referral anomalies Perth area Medical Records Stracathro Hospital All Mental Health referral anomalies Angus area Any questions in relation to process and procedures around this please contact lindafox@nhs.net or heatheranderson@nhs.net or doreenfechlie@nhs.net 31

32 TOPAS QUEUED FAILURES 32

33 VIEW OF A FAILURE 33

34 RESUBMISSION OF A FAILURE 34

35 RMS ELECTRONIC REFERRAL PRINTING RMS referrals are printed at a location agreed; THIS SHOULD NOT BE COMPLETED UNTIL AFTER 12.30pm DAILY (UNLESS OTHER WISE INFORMED) and at this point the following steps should be taken to ensure no information is missed: Access the system as a Print User and select each of the following individually: PRINTING SPOOLER WITH NO ATTACHMENTS PRINTING SPOOLER WITH ATTACHMENTS PRINTING SPOOLER FOR BOOKING REQUESTS 35

36 Print each list individually by selecting Print entire Queue. There is also the functionality to print an individual letter if required by selecting the print option alongside the patient s name. If a referral is printed individually please ensure this is noted when printing the whole list as figures will not tally when confirming the prints. 36

37 Once all queues have been printed, there could be attachments that were not recognised by the system. If this is the case an error message will appear and request SCI Attachments to action. This area is located on the left hand side of the screen and once clicked on the attachments can be found and printed. 37

38 When all queues are printed and all attachments are married up, logout switch account to Medical Records User for this location. Select Confirm Prints for printed letters with and without attachments and take a copy of the list of patients. Select Confirm Bookings for letters on-line screened by clinicians and take a copy of the list of patients. Carefully match up the list with the paper referrals to ensure all clinical information has been received. When the printed information is passed to appointing staff they will be responsible for verifying the information in the printed referral with the Topas TRMS tab to ensure the information flow is correct and accurate, this will include redirection information and sub-specialty any anomalies should be reported to lindafox@nhs.net, heatheranderson@nhs.net and doreenfechlie@nhs.net 38

39 All referrals, where the manual transfer of referral information was required, due to RMS anomaly, will require input into Topas, there will be an indication on the referral that this is the case, but as the process has indicated in this document all information should be checked in Topas to ensure governance is in place, so any referrals where the manual process was required should be detected. 39

40 Unavailability On completing a referral General Practice can provide information on Unavailability and the reason why. This information, at present, will not auto-populate Topas and requires manual input in the Unavailability tab in the Patient Referral screen. This should be completed by the Department responsible for adding the referral only, or completing the whole process of adding the referral, appointing or adding to the Waiting List, the unavailability is applied at the point of the referral being added. RMS View of Unavailability 40

41 CHECKING RMS CANCELLATIONS The cancellations page in the Referral Management Service (RMS) should be checked regularly (every day). GP practices should be contacted, where necessary, to inform about the cancellation or to acknowledge the cancellation (referrals from out with Tayside do not receive the clinical information included in the cancellation details, therefore these practices must be informed). All printed cancellation referral letters should be matched against the linked data in Topas to ensure all information, and the reasons, have passed through. 41

42 PAPER REFERRAL LETTERS PAPER/FAX/BOARD TO BOARD/CONSULTANT TO CONSULTANT All paper referral letters received should be date stamped on arrival in Secondary Care (this includes at Unit Level). If the referral is received at Unit Level, Medical Records should be made aware of the referral as soon as possible (no longer that 48 hours from receipt but Saturday, Sunday and Public Holidays will be taken into account). Clinical advice (vetting info) should be provided to Appointments/Booking Staff as to the urgency, location of attendance and any special needs of the patient, (Diabetes, Hearing Difficulties etc), to allow the appropriate appointment to be made for the specialty. UK VETERANS Any patients who have suffered ill health or injury related to their past or current service are entitled to be fast tracked, providing there are no other patients with a greater clinical need. In addition to this, patients currently on a waiting list for in-patient or out-patient services, who are dependents of Service Personnel, and move Health Board, are entitled to be placed back onto the same place on the Waiting List in the new Health Board. For electronic referrals GPs should tick the if patient is an armed forces veteran please tick this box (this should be selected if the patient is Veteran, current or past, or the patient is a dependant of a Veteran e.g. son, daughter, wife) or this may be indicated in body of the referral letter, for electronic, or paper referrals. When possible, clinical staff should manually highlight this when screening the referral. Information on Veterans flags should be sent to Linda Fox, lindafox@nhs.net and Heather Anderson, heatheranderson@nhs.net including patient s name, CHI, location & speciality of referral, GP and screening information to allow the patients to be appropriately dealt with. 42

43 ONWARD REFERRALS The following process should be adhered to for referrals from NHS Fife. Staff in Ninewells will check the hub through their system (nongpreferral) on a daily basis. If a referral is received it will be transferred into the locality folder, i.e., Angus, PRI or Ninewells. If the referral information meets the minimum data set (see below), an acknowledgement receipt will be returned to the referrer to confirm acceptance of the referral. The staff in the locality will be sent an to ask them to access the folder. They will then print the letter, input into TOPAS (with a comment in the free text field NHS Fife Referral ) and pass to the Department for priority and onward pathway. On passing this information on, it is the responsibility of the Waiting Times Co-ordinator for each specialty to monitor, track and ensure the pathway of care is completed, therefore an on sending to the Department to the Waiting Times Co-ordinator for this specialty should be sent to allow them knowledge of the referred, with a copy to both Linda Fox (lindafox@nhs.net) and Doreen Fechlie (doreenfechlie@nhs.net). Minimum Data Set: Patient Name CHI UCPN Original Date of Referral Periods of Unavailability Expected Target Date Heading in Subject Document Type SpecialtyCHI Date of Referral (DD/MM/YYYY) Example: Referral, Cardiology, , 21/06/11 Waiting Times Co-ordinators:- Specialist Services Alison Kelly/Val Batchelor Ophthalmology Alison Simpson/Alison Collins Surgical Anne McOmish Orthopaedic Karen Blackwood. 43

44 ADDING ALL REFERRALS TO TOPAS ALL referral letters (paper, screened or non-screened) should be added to Topas on receipt (within 48hrs of receipt) by Referral/Appointment staff in Secondary care there should be no delay waiting for vetting or tests etc. Referrals which have been cancelled should still be added to Topas and filed in the patient s case notes, even if this means raising new case notes. Check Patient Details Before adding a referral (paper or electronic) onto Topas the Patient Details screen should be accessed to ensure all the demographic information (including GP) for this patient is accurate and saved into the system. 44

45 ADDING A REFERRAL Date of Receipt of Referral a) RMS referrals - this is the date the referral has arrived electronically from General Practice to Secondary care, which is the submitted date (unless the referral has hit the SCI Deadmessage file, in which case Linda Fox will inform Medical Records to allow information to be accurately input into Topas). If a clinician, whilst screening, clinically delays the referral for testing purposes, of awaiting more information from GP etc, the date of referral is still the same, date of electronic receipt, this is also the case if the referral is redirected from one service or location to another. b) Paper referrals - this is the date received by secondary care which should be date stamped on receipt by either medical records or Unit level, whichever is first. c) Bowel Screening Service Referrals - this is the date of the SCI-Gateway referral d) Cervical Screening Colposcopy Referrals - this is the date the abnormal smear result was reported. e) EMS Recall this is the date of report of the chest x-ray Serial Number For RMS referrals only this is the number quoted along the top of the referral prefixed by a T e.g. T The serial number should only be recorded on Topas against one referral. If the Clinician has indicated more than one condition or more than one attendance pathway the first consultant attendance should be recorded as a GP source of referral, any tests should be recorded as a Consultant referral. Any Test only appointments should be recorded as a GP referral. The T number should only be recorded against the GP referral. All referrals received from a Health Board outwith NHS Tayside e.g., NHS Fife should be recorded with a UCPN (Unique Care Patient Number) this number/letter code should be recorded in the Serial number field, with a referral source code of 4 - Consultant from a Provider Unit outwith this Health Board. A minimum dataset of Requested Consultant Name of the clinician referred to by General Practice if quoted Requested Specialty Name of the specialty referred to by General Practice e.g. C5 ENT Requested Priority a) RMS Referrals - this is the priority selected by General Practice e.g. Urgent or Routine (at present all Urgent Suspected Cancer should be added as Urgent ). b) Paper Referrals this is the priority recorded by General Practice, e.g. Urgent or Routine. If suspicion of cancer is indicated in the body of the referral, this information must be passed to the Referral Co-ordinators to allow tracking of the patient. 45

46 Category of Referral This will default to OP Outpatient, this should be changed if the referral has the following: Canc (Cancer) this code should be recorded if: the priority set by General Practice is Urgent Suspected Cancer Suspicion of Cancer is indicated in the body of the paper referral the referral is from Bowel Screening or Cervical Screening the referral is an EMS recall CAT (Cataract) or CAT2 (Cataract 2 nd eye) record this code if the Specialty is Ophthalmology C7 LGB to be recorded if the referral is for General Surgery Cholecystectomy Pathway DIAG to be recorded for Cardiology Test, e.g. ETT, Echo, 24 hour Tape HDRA code to be recorded for Rapid Access Chest Pain Service ERP Exceptional Aesthetic Referral Protocols - record this code if the screening user has indicated ERP in the RMS notes (this is for patients referred for a cosmetic reason and the clinician has accepted the patient for treatment but they are not included in the waiting times targets SCANC - to be recorded if a patient is sent in with a priority of Routine or Urgent and this is clinically upgraded to Urgent Suspected Cancer this is a future development and will be implemented in the 3 rd quarter of this year. Source of Referral: Type - 1 GP should be recorded if the referral has came from General Practice. If a referral has more than one decision for the onward pathway, this needs to be recorded appropriately. If a referral was sent by General Practice for consultation and is vetted for clinic & test the clinic should be recorded as the GP referral (with the serial number if electronic) and the test should be recorded as a consultant referral (with no serial number recorded). Referrals sent from Medical Bases e.g. RM Condor, RAF Leuchars etc, should be recorded as GP Type 9 and free-text referred from the specific base e.g. RAF Leuchars. Cervical Screening Colposcopy Referrals should be recorded as 1 GP Bowel Screening Service Referrals should be recorded as O - Community Health Service GP/Practice The referring GP should be recorded, to allow information to flow back to the referring clinician in General Practice. To enter this information, untick the local box and type the name of the referring GP. Corr GP The registered GP should be recorded here, to allow information to flow back to the referring clinician in General Practice. To enter this information, untick the local box and type the name of the registered GP. 46

47 GP Date a) RMS Referrals this is the date the GP submits the referral, which is the submitted date. b) Paper Referrals this is the date typed by the Practice admin staff. c) Bowel Screening Service Referrals this is the date of the SCI-Gateway referral. d) Cervical Screening Colposcopy Referrals this is the date the abnormal smear result was reported. e) EMS Recall - this is the date of the abnormal chest x-ray report. Notes Please type any relevant information into the notes box e.g. Breast patient if sent in as General Surgery. Decision Code A decision code should always be entered for a referral, this closes or temporarily closes off a referral: CAN Referral Cancelled COM Referral closed off with a comment DEC Patient Deceased DUP Duplicate referral NVA Not Vetted, Not Appointed VNA Vetted, Not Appointed CON Consultant TKT Appointment Ticket PSA Pat Subsequently Appointed 47

48 Paper Referral Date of 1 st Date Stamp RMS Referral Date Submitted BOSS Referral Date of SCI referral Cervical Screening Date of abnormal smear report EMS Recall date of abnormal chest x- ray report Electronic Referrals only record the prefixed T number located at the top of the printed Referral Name of Consultant Referred to by GP Name of Specialty Referred to by GP The priority set by the GP Urgent Suspected Cancer CANC Cataract CAT or CAT2 Cholecystectomy LGB Cardio Test DIAG Rapid Access Chest Pain Service HDRA ERP CAN - Referral Cancelled COM - Referral Closed with Comment DEC - Patient Deceased DUP - Duplicate Referral NVA - Not Vetted or Apptd VNA - Vetted Not Apptd CON Consultant TKT Appointment Ticket PSA Pat Subsequently Apptd e.g. Referring GP Consultant Other e.g. RAF Leuchars Paper Referral Date typed by Practice admin staff Electronic Referral Date Submitted Name of the Registered GP 48

49 Adding Vetting Information If screening information is provided this should be added to the Allocated part of the screen, by clicking the Vet button. This information should be analysed to ensure the information provided has not changed, any changes should be applied to the screen at this point. Allocated Consultant Name of the suggested clinician (if any) in the screening information. Allocated Specialty Name of the allocated specialty in the screening information, this may be different from the requested speciality, if the referral has been redirected. Allocated Priority The priority set by the screening clinician, this may be different from the requested priority if the screener deems the referral more or less urgent. Please ensure if reclassifying this referral from Urgent Suspected Cancer to Routine or Urgent priority that the Cancer category is ticked for tracking purposes. 49

50 Name of the Allocated Consultant Name of the Allocated Specialty The priority set after Consultant Vetting SCANC Upgraded referral to USC CAN - Referral Cancelled COM - Referral Closed with Comment DEC - Patient Deceased DUP - Duplicate Referral NVA - Not Vetted or Apptd VNA - Vetted Not Apptd CON Consultant TKT Appointment Ticket PSA Pat Subsequently Apptd Paper Referral Date typed by Practice admin staff Electronic Referral Date Submitted All referrals received into Topas though the RMS/Topas link will populate or be input into Topas manually. For specialties where systems are used other than Topas to record their referral the Service receiving the printed referrals will be responsible for closing off the episode in Topas with a decision code of PSA (Patient Subsequently Appointed). It is important these referrals are closed off and reports will be issued to areas with outstanding referrals. NOTE: THERE MAY BE FURTHER CATEGORIES/OPTIONS ADDED IN THE FUTURE, DEPENDING ON THE NEEDS OF THE SERVICE. 50

51 1.7.2 Standard Operating Procedure 2 Project: Patient Focused Booking Process Project Reference: Ruth Anderson Originator: Sandra Cassidy Date: 1 st October, 2012 Operation Name & No. Patient Focused Booking Process Page 1 of 3 Special Requirements A full set of TOPAS training notes for appointing out patients can be found in Staffnet under: CLINICAL ADMIN SYSTEMS TOPAS TOPAS APPOINTMENT USER GUIDE PFB USER GUIDE TICKET HOPPER USER GUIDE Issue 2 Safety Tools/ Clothing Tools/ Equipment PC, TOPAS, Intranet (TOPAS Training Material), SOP s from All Other Specialties, Telephone, Printer and Letter Folding Machine No Main Operating Steps Key Points Explanation/Examples/ 1 Referral letters either electronic or paper are received into the department. Electronic referrals are already vetted and will populate TOPAS from RMS. If the referral has been sent by the clinician, the team log the patient referral details onto Topas. The date of receipt of referral is when the clock starts ticking for 18 Weeks RTT. Diagrams 2 Medical Records admin staff manually change e-referrals which have failed to reach TOPAS from RMS due to anomalies/mismatches. They will check that patient demographics and telephone number match the referral letter and update TOPAS accordingly. Checks are vital as patient referrals can be recorded by another department and patient contact details must be accurate. It is important that telephone numbers are recorded on TOPAS as patients are often telephoned with an offer of appointment. 3 Booking team will add the patient to the appropriate waiting list from the Patient Referral Screen. These patients are suitable for booking under PFB arrangements as there is likely to be a wait of 4 weeks or more for the appointment. Patient added to the waiting list (hopper). TOPAS will prompt user to print an acknowledgement letter to patient click yes Choose appropriate acknowledgement letter for specialty. Acknowledgement letter is sent to advise the patient that the referral has been received and that the booking team will contact them nearer to their appointment date. The acknowledgement letter will also give patients a guide to their guarantee and how NHS Tayside s appointment process works. 4 From the PFB Tab in TOPAS, print the invitation list and patient invitation letters. Send letters to patients. The invitation lists have been generated by the TOPAS system having checked the amount of vacant new routine slots in the clinics up to six weeks in advance. At this point the patient is allowed

52 5 Patient contacts the booking office 6 Book appointment for patient and send letter including any patient information leaflets. 7 If patient does not respond to invitation letter after 14 days, in TOPAS print a reminder list of patients who have not responded for appointment from the PFB Tab. 8 Patients can be contacted by telephone to offer appointment. 9 For patients who have not been contacted by telephone print reminder letters from TOPAS PFB Tab. 10 Send reminder letters to patients. 11 If the patient contacts the Booking Team, a suitable appointment date and time can be agreed with the patient. Appointment letter will be generated by system with confirmation of appointment. Ask patient for ticket number from invitation letter found at top right of letter. Enter the ticket number in the appointment ticket screen in TOPAS and this will display the appropriate waiting list and the clinic that the patient can be booked to. Agree convenient appointment with patient, recording declined offers and periods of unavailability advised by patient. TOPAS will generate the appointment letter confirming the appointment date, time, and venue and contact details. TOPAS flags patients who have not yet responded on a daily basis. Check demographics in case of change and check that patient has not already been appointed or had a duplicate referral. If patient is successfully contacted, book appointment with patient or remove from the waiting list as instructed by the patient. TOPAS automatically records a period of social unavailability with a review date of 14 days. This is shown with a comment Auto created with Reminder Letter Ask patient for ticket number from invitation letter found at top right of letter. Enter the ticket number in the appointment ticket screen in TOPAS and this will display the appropriate waiting list and the clinic that the patient can be booked to. System will not allow appointment to be made until period of unavailability has ended. The booking team must record this date in TOPAS on the day that the 52 two weeks to contact the Booking Team to arrange an appointment. Refer to Hopper User Guide. Refer to PFB User Guide. Refer to PFB User Guide. This period of unavailability is added onto the patients wait in line with 18 Week RTT. Patients have 14 day to respond to the reminder letter. Refer to PFB User Guide. Although patient is allowed up to 14 days unavailability, the date the patient contacts the booking team is the date the unavailability is ended.

53 12 Print unconfirmed removals list from TOPAS from PFB Tab. 13 Remove patient from waiting list. 14 Print removal letters from PFB tab. 15 Send out removal letter to patient and GP, both letters are automatically generated by system. patient telephones to make appointment. Agree convenient appointment with patient, recording declined offers and unavailability. If patients do not contact within 14 days reminder period, patients can be removed from the waiting list From appointment ticket screen select patient pending removal and record in comments PFB Removal No Response Therefore if patients contacts on 7 th day the period of unavailability is recorded as 7 days. This is a list of patients who have not responded to invitation and reminder letters. 53

54 1.7.3 Standard Operating Procedure 3 Project: Direct Booking for New Out Patient Appointment Operation Name & No. Special Requirements Project Reference: Ruth Anderson Direct Booking for New Out Patient Appointment A full set of TOPAS training notes for appointing out patients can be found in Staffnet under: CLINICAL ADMIN SYSTEMS TOPAS TOPAS APPOINTMENT USER GUIDE TICKET HOPPER USER GUIDE Originator: Sandra Cassidy Date: 1 st October, 2012 Page 1 of 2 Issue 2 Safety Tools/ Clothing Tools/ Equipment PC, TOPAS, Intranet (TOPAS Training Material), SOP s from All Other Specialties, Telephone, Printer and Letter Folding Machine No Main Operating Steps Key Points Explanation/Examples/ Diagrams 1 Referral letters either electronic or paper are received into the department. Electronic referrals are already vetted and will populate TOPAS from RMS. If the referral has been sent by the clinician, the team log the patient details onto TOPAS. The date of receipt of referral is when the clock starts ticking for 18 Weeks RTT. 2 Medical Records admin staff manually change e-referrals which have failed to reach Topas from RMS due to anomalies/mismatches. They will check that patient demographics and telephone number match the referral letter and update Topas accordingly. Generate a Direct Booking Acknowledgement letter Checks are vital as patients referrals can be recorded by another department and patient contact details must be accurate. It is important that telephone numbers are recorded on TOPAS as patients are often telephoned with an offer of appointment. When referral is logged and vetted in Topas print acknowledgement letter DIRECT ACK, or from referral screen user can select print acknowledgement letter from the referral menu options. This letter should be sent along with patient appointment letter. 54 This additional letter will give patients a guide to their guarantee and how NHS Tayside s appointment process works. 3 Booking Team sort patient s referrals by priority i.e. Urgent and Routine and separate into specialty. 4 Direct Booking is suitable for Appointments should not be offered This is to ensure that patient

55 patients who are not being added to a waiting list, for example Urgent priority or Routine patients who can be booked to clinics with a short wait. Booking team will book patients in order of clinical priority (urgent first) and then routine patients in order of date referral received. 5 Book patient to correct speciality/clinc/consultant as instructed on referral letter and ensure that correct referral letter is attached to new appointment. 6 Send confirmation letter and acknowledgement letter to the patient and include any patient information leaflets. or booked more than 6 weeks in advance unless service planning is in place to ensure that firm dates are available. Try to contact by telephone any patient who is being booked in less than one week from appointment date. All routine patients must be offered a reasonable offer package. Should a patient decline a reasonable offer of appointment this must be recorded as declined offer in TOPAS and record any periods of unavailability as advised by patient. If approval is given to offer a patient into a breach slot and the patient declines this offer, then this should not be recorded as declined on Topas as this was not a reasonable offer and the patient had already breached. Each speciality will have agreed/confirmed clinic templates. If permission is given to edit/add slots ensure that correct appointment type is recorded eg changing a new slot to a return slot. Keep slot times within the agreed template. If over booking is allowed user must record who has authorised the over booking in the notes within TOPAS. Confirmation letters are automatically generated by TOPAS and the letter will detail the appointment date, time, venue and contact details. If the patient makes contact to decline the offered appointment date a further reasonable offer appointment should be offered. If the patient makes contact to move the appointment after a reasonable offer package has been accepted this should be recorded as moved by patient and the patient s waiting time clock would be reset to zero from the date that the patient made contact. 55 appointments will not be moved should the clinic be cancelled. Refer to TOPAS Appointment User Guide This is to ensure that the patient is informed of appointment date, time and venue should the letter not arrive in time. Refer to TOPAS Appointment User Guide Refer to TOPAS Appointment User Guide.

56 1.7.4 Standard Operating Procedure 4 Project: Applying Medical & Patient Advised Unavailability Operation Name & No. Special Requirements Tools/Equipment Purpose What is Unavailability? There are 2 types of unavailability. No Main Operating Steps 1. Recording known Medical unavailability on TOPAS. Project Reference: Ruth Anderson Applying Medical & Patient Advised Unavailability A full set of TOPAS training notes for applying unavailability can be found in Staffnet under: CLINICAL ADMIN SYSTEMS TOPAS APPOINTMENT USER GUIDE WAITING LIST USER GUIDE PC, TOPAS System, Intranet, TOPAS training material, SOPs from all other specialties, telephone, printer. The purpose of this SOP is to provide guidance around recording of patient unavailability in TOPAS, promoting good practice and achieving consistency of service following the guidance provided under New Ways rules. Patients who are awaiting an appointment as a New outpatient or are awaiting an Admission date should have any period that they are unavailable to attend or come in recorded on TOPAS as per new Ways Guidance. Within these guidelines, time recorded as unavailable for treatment will be subtracted from a patient s reported waiting time, regardless of the length of time unavailable. Patient Advised Unavailability when the patient cannot attend due to their own circumstances. Medical Unavailability when a Medical condition prevents the patient being appointed/admitted. Key Points Medical unavailability can be recorded from the patient referral screen, patient details screen, appointment ticket screen, booking screen and waiting list entry screen. Periods of unavailability can be viewed from the patient appointment screen. Patients who do not have an end date for 56 Originator: Sandra Cassidy Date: 1 st October, 2012 Page 1 of 4 Only periods of unavailability that are before the patient s personal guarantee date will be taken into account. Both types of unavailability can be: Specific only applicable to a certain referral/waiting list entry/pathway. Universal applicable to all of TOPAS. This prevents appointing across all of Tayside regardless of specialty. Explanation/Examples/Diagrams A start and end date must be entered. A drop down box will appear to record mandatory reasons for medical unavailability. Specific unavailability should only be entered from the patient

57 unavailability can be recorded with a review date. Medical Unavailability should only be applied on the instruction of a clinician. referral screen as this usually refers to an individual specialty. Medical unavailable patients should not be added to a waiting list if there is no end date to their unavailability. 2 The recording of the reason for medical unavailability is mandatory on Topas 3 Medical unavailability with a review date (Indefinite). 4. Patient informs the booking team that they cannot attend their reasonable offer of appointment due to a period of Patient Advised Booking staff should pick the reason from the drop down list Free text can be entered to record additional information. This period should be no longer than 12 weeks. All periods of patient advised unavailability will have a start date and end date recorded and TOPAS will subtract this time from the patient s waiting time. Patient Advised unavailability can be recorded from the patient referral screen, patient details 57 Medical Unavailability reasons are: Medical - Other medical condition Medical - Indefinite Unavailability There is a report in Topas which lists patients with a review date. If at the end of the review period, no end date is known, advice should be sought from the responsible Healthcare Professional. A further review period of 12 weeks can be applied. After this further period of 12 weeks, unless clinically inappropriate, the patient should be removed from the waiting list and returned to GP care. If remaining on the waiting list the reason should be recorded and a new review date recorded. The patient and GP should be informed if the patient is being removed from the list and GP can re-refer. The Unavailability should be ended by applying an unavailability outcome code (TOPAS to be updated). A start and end date must be entered. A drop down box will appear to record mandatory reasons for patient advised unavailability. Patient Advised unavailability can be used in the following circumstances:

58 unavailability. This is known unavailability. 5 The recording of the reason for patient advised unavailability is mandatory on TOPAS screen, appointment ticket screen, booking screen and waiting list entry screen. Periods of unavailability can be viewed from the patient appointment screen. Patients who do not have an end date for unavailability can be recorded with a review date. Booking staff should pick the reason from the drop down list Free text can be entered to record additional information. A confirmation of unavailability letter will be available to send to the patient from TOPAS (details to follow once TOPAS updated). If a patient requests named consultant or specific location: Start Date of the period of unavailability will be the date when the patient has advised that they wish to be seen by a specific consultant/location. End date of the period of unavailability will be the date of the appointment 58 When a patient cannot accept a reasonable offer due to a holiday or family/work commitments When a patient does not want to accept a reasonable offer package of treatment out of Board area. When a patient asks to be seen by a specific clinician or at a specific location. Specific unavailability should only be entered from the patient referral screen as this usually refers to an individual specialty. Patient Advised unavailable patients should not be added to a waiting list if there is no end date to their unavailability. Patient Advised Unavailability reasons are: Patient Advised on holiday Patient Advised personal commitment Patient Advised work commitment Patient Advised Carer commitment Patient Advised academic commitment Patient Advised Jury Duty Patient Advised wishes named Consultant Patient Advised wishes specific location Patient Advised Visiting Consultant Service patient wishes to be seen at next scheduled service within Board of residence Patient Advised following severe weather cancellation of Visiting Consultant Service, wishes to be treated

59 6 Patient advised unavailability with a review date. (Indefinite unavailability) 7 For all types of unavailability This period should be no longer than 12 weeks. A letter will be automatically available from TOPAS (subject to new software release) confirming the patient s unavailability period and the effect on the patient clock. If a To Come In date has been set for a TTG patient a new Wait Statement (subject to new software release) will be available and should be printed and sent to the patient. 59 within local Health Board Patient Advised - Indefinite Unavailability Suspension due to exceptional circumstances There is a report in Topas which lists patients with a review date. If at the end of the review period, no end date is known, advice should be sought from the responsible Healthcare Professional. A further review period of 12 weeks can be applied. After this further period of 12 weeks, unless clinically inappropriate the patient should be removed from the waiting list and returned to GP care. If remaining on the waiting list the reason should be recorded and a new review date recorded. The patient and GP should be informed if the patient is being removed from the list and GP can re-refer. The Unavailability should be ended by applying an unavailability outcome code (TOPAS to be updated) Note: Patients booked using the PFB process will have an automated period of Patient Advised unavailability recorded with a start and review date of up to 14 days if patient has not responded to invitation letter. An end date should be entered on the day the patient makes contact to book appointment.

60 1.7.5 Standard Operating Procedure 5 Project: Cancelled and Moved Appointments Project Reference: Garry Collins Originator: Sandra Cassidy Date: 1 st October, 2012 Operation Name & No. Cancelled and Moved Appointments Page 1 of 4 Special Requirements A full set of TOPAS training notes for appointing out patients can be found in Staffnet under: CLINICAL ADMIN SYSTEMS TOPAS TOPAS APPOINTMENT USER GUIDE TOPAS WAITING LIST USER GUIDE Issue 3 Safety Tools/ Clothing Tools/ Equipment PC, TOPAS, Intranet (TOPAS Training Material), SOP s from All Other Specialties, Telephone, Printer and Letter Folding Machine No Main Operating Steps Key Points Explanation/Examples/Diagrams Appointment Moved By Patient 1 Patient contacts the booking team to move an existing agreed appointment or admission date. This should be recorded in TOPAS in Patient Appointment Screen or waiting list entry as Moved by Patient (MP), also record any periods of unavailability in TOPAS as advised by patient. If a patient contacts the hospital to cancel their appointment on the day of their appointment this should be recorded as a DNF and a further appointment given. Refer to TOPAS Appointments User Guide and Waiting List User Guide 2 Booking team to agree a suitable appointment date and time with the patient. For inpatients/day-cases it is unlikely that a further admission date will be offered. 3 Booking team send confirmation letter detailing changed appointment to patient. It is important that it is explained to the patient that as they are requesting a change to an agreed appointment/admission date then their waiting time clock will be reset to the date that the cancellation is requested. Urgent patients will not have their waiting time clock reset. Should a patient move their appointment three times, contact the Consultant/Clinical Services Manager to refer the patient back to their GP unless advised by Clinicians that it is clinically appropriate to re-appoint the patient. This should be documented by the clinician in the casenotes. TOPAS automatically generates the new appointment letter confirming the new appointment date, time, and venue and contact details. 60 Refer to TOPAS Appointments User and Waiting List User Guide For inpatients and day-cases, the admission date is to fit in with the clinician and theatre list. It is unlikely to be known when this can be rescheduled when patient contacts the service. This does not happen for waiting list entries.

61 4 Patients who advise that they cannot attend due to a minor illness (cough, cold, etc.) For patients attending an outpatient appointment should be recorded as Move by Patient (MP). If an accepted reasonable offer then this move will reset the patient s waiting time clock. Appointment Cancelled By Patient 1 Patient contacts the booking team or waiting list office to cancel an existing agreed appointment or admission date. 2 Booking team then cancels the appointment in TOPAS from the Patient Appointment Screen. Urgent patients will not have their waiting time clock reset. For patients attending for elective surgery/procedure, then the relevant clinician should be advised. If clinician decides that the illness would prevent treatment then he/she may decide that medical unavailability should be applied. If the clinician decides that treatment can go ahead then this should happen. If the patient decides they cannot attend, then the waiting time clock should be reset. Should a patient move their appointment three times, contact the Consultant/Clinical Services Manager to refer the patient back to their GP unless advised by Clinicians that it is clinically appropriate to re-appoint the patient. This should be documented by the clinician in the casenotes. This should be recorded in TOPAS in Patient Appointment Screen as Cancelled by Patient (CP). IP/DC waiting list patients should be removed from the waiting list with the appropriate removal reason and ensure the date of removal is correct. Patient should be advised that if after cancelling this appointment they wish to have a further appointment they would 61 Refer to TOPAS Appointments User Guide and Waiting List User guide As the patient does not want another appointment this will stop their waiting time clock. The patient cannot be given another appointment without a new referral from Clinician/GP. Refer to TOPAS Appointments User Guide or Waiting List User guide as appropriate. Add any comments regarding the reasons for patient cancelling appointment. IP/DC patients if booked OPERA to be notified of cancellation.

62 3 Booking team should endeavor to fill vacant slots. 4 IP/DC cancellations should be notified to Consultant, GP and, if TCI date given, OPERA. Appointment Moved By Hospital 1 Service contacts the booking team on behalf of Clinician to cancel clinic. 2 Booking team will flag clinic as cancelled and record reason for cancellation in TOPAS. 3 Booking team will reschedule the clinic and re-appoint patients. IP/DC waiting list entries cannot be automatically re-appointed. have to go back to their GP to be rereferred. Booking team to check the hoppers and book the patient who is at the top of the waiting list if appropriate. Six weeks notice is required from the service for a Hospital clinic cancellation. If less than six weeks notice for cancellation is received this is defined as a short notice cancellation and must be approved on the appropriate form by the Clinical Services Manager. Booking staff should choose appropriate reason from drop down list and also tick short notice box if less than 6 weeks. Patients should be recorded in TOPAS as Moved by hospital (MH) Patients should be re-booked as close to their original appointment date as possible and within their waiting time guarantee. In some cases a clinic may be reduced in terms of the number of patients attending, if these clinics contain patients who have been previously moved, avoid moving these patients again. The numbers of moves are shown on Topas. 62 As a consequence of a patient cancelling their agreed appointment, vacant slots will arise before the clinic date and every attempt should be made to appoint patients to cancelled slots, the longest waiting patient should be appointed into a vacant routine slot. For waiting list entries the next person on the waiting list who is best fit for the theatre slot should be chosen to replace the cancelled patient. Refer to TOPAS Appointment User Guide or TOPAS Waiting List User Guide. All clinic cancellations including short notice are extracted from TOPAS by the Information Team for recording purposes. Refer to TOPAS Appointment User Guide or TOPAS Waiting List User Guide. Patient clinic appointments moved by the hospital do not have their waiting time clock stopped. Patients who have been previously moved will be shown in TOPAS as MH.

63 Staff should check referral date and reschedule patients in order of referral date. Waiting List Office staff should ensure that patients are re-booked within their guarantee. Waiting List patients will not be rescheduled but will have MH recorded against the waiting list entry. 4 Booking team send confirmation letter detailing the change of appointment time and date if appropriate. New admission letters will be sent in due course to patients. Appointment Cancelled By Hospital 1 Clinical Team contact the booking team to cancel an existing agreed patient appointment/waiting list entry. The Clinical Team will contact the patient regarding the reasons for the cancellation. 2 Booking team then cancels the appointment in TOPAS from the Patient Appointment Screen. 4 Booking team should endeavor to fill vacant slots. Patient should be offered further appointments taking account of their reasonable offer package. If the cancellation is a week from the clinic/admission date every attempt should be made to contact the patient by telephone. TOPAS automatically generates the new appointment letter confirming the new appointment date, time, venue and contact details. Not applicable for IP./DC waiting list patients This clinical decision means that the patient is not offered another appointment. This should be recorded in TOPAS in Patient Appointment Screen as Cancelled by Hospital (CH). Booking team to check the hoppers and book the patient who is at the top of the waiting list if appropriate. 63 Refer to TOPAS Appointments User Guide or TOPAS Waiting List User Guide Refer to TOPAS Appointments User Guide or TOPAS Waiting List User Guide As a consequence of the hospital cancelling an agreed appointment, vacant slots will arise before the clinic date and every attempt should be made to appoint patients to cancelled slots, the longest waiting patient should be appointed into a vacant routine slot. For waiting list entries the next person on the waiting list who is best fit for the theatre slot should be chosen to replace the cancelled patient.

64 1.7.6 Standard Operating Procedure 6 Project: Patient Non- Attendance Operation Name & No. Special Requirements Tools/Equipment Project Reference: Kerry Wilson Patient Non-Attendance for appointments and treatment Did not Attend A full set of TOPAS training notes can be found in Staffnet PC, TOPAS, Intranet, Access Policy, telephone, Printer. Originator: Ruth Anderson Date: 1 st October, 2012 Page 1 of 5 Issue No Main Operating Steps Key Points Explanation/Examples/Diagrams Did Not Attends Out Patients 1. Health Records and Outcomes Sheets for all patients that do not attend for an appointment are given to the clinician at the end of each clinic in order that a clinical decision is made regarding the next steps. If a patient contacts the hospital to cancel their appointment on the day of their appointment this should be recorded as a DNF and a further appointment given. An outcome sheet is completed for all out patients, including patients who do not attend. It is a clinical decision whether the patient should be offered another appointment or referred back to the referrer. 2. If the clinical decision is that the patient is being referred back to the referring clinician then the date of the patient s non attendance should be recorded in the health records by the clinician along with the reason why this was clinically appropriate to refer the patient back. The clinician must write to the referring clinician and patient (and carer if appropriate) advising them of their decision. 64 As per the Patient Rights (Scotland) Act 2011: Health Boards must inform patients of the consequences of not attending an agreed appointment. This information will be provided in the Out-Patient Acknowledgement Letter. The letter sent to the patient following a did not attend, where the patient is being referred back to referring clinician should include the following paragraph: Our records show that you have not attended the appointments offered to you. When you were referred to this hospital, we advised you that if you did not attend your appointments your need for treatment would be reviewed. As a result of this we have taken your name off our waiting list. Your referral will remain on file for 4 weeks and can be reactivated during this time by contacting the outpatient service. If you have not contacted the service within this period you will

65 The clinician should tick DNG did not attend refer back to referring clinician, on the outcome sheet and return this to the reception staff. remain as discharged. If you would like another appointment after the 4 week period, please contact your GP so that they can make another appointment for you. 3. Reception staff must record the DNG outcome on TOPAS (refer to Topas User Guides and Clinical Outcome Crib Sheet) Recording DNG in TOPAS will stop the waiting time clock. Referrals can be reactivated if the patient contacts the hospital within a 4 week period. If the patient or referrer has not contacted the hospital within this period the patient will remain as discharged. 4. If the clinical decision is that the patient is being offered a further appointment then the clinician should record DNF did not attend, further appointment, on the Outcome Sheet, indicate when the appointment should be and return to reception staff 5. Reception staff must record the DNF outcome on Topas and re appoint as per clinician s instruction. Refer Topas User Guide DNF/DNT for a routine appointment will reset the clock DNF/DNT for an urgent appointment will continue the clock. Staff must remember that an urgent patient s DNF/DNT will not reset the waiting time clock to zero and any further appointment must be booked with the patients waiting time guarantee. If a routine patient does not attend an out-patient appointment the waiting time clock will be reset to zero. If an urgent patient does not attend an urgent outpatient appointment it is considered unreasonable and clinically inappropriate to reset the clock for zero, therefore an urgent patients waiting time clock will continue and the patient will have to be offered a further appointment within their guarantee time. If further appointment cannot be made patients can be returned to the out-patient waiting list, but have to use the outcome code of DNT. 65

66 Did Not Attends In-Patient/Day Cases 1. If a patient does not attend for in-patient/day case treatment Clinical staff must indicate whether the patient should remain on the waiting list or be referred back to the referring clinician. 2. If the clinical decision is that the patient is being referred back to the referring clinician then the date of the patient s non attendance should be recorded in the health records by the clinician along with the reason why it was clinically appropriate to refer the patient back. The clinician must write to the referring clinician and patient (and carer if appropriate) advising them of their decision Clinicians should tick DNG did not attend refer back to referring clinician, on the waiting list slip and return this to the admin staff 3. Admin staff should record DNG in the waiting list on TOPAS (refer to Topas Waiting List User Guide). Letter explaining that the patient did not attend and is being referred back to referrer should be sent to referrer and GP Recording DNG in TOPAS will stop the waiting time clock. As per the Patients Rights (Scotland) Act 2011: Health Boards must inform patients of the consequences of not attending an agreed appointment. This information will be provided in the Out-Patient Acknowledgement Letter. For patients under the Treatment Time Guarantee, if the patient is referred back to their referring clinician the NHS Tayside must write to the patient, the patient s referring clinician, and where appropriate, the patient s carer to inform them of this. 66

67 4. If the clinical decision is that the patient is being offered a further admission date then the clinician should record DNF did not attend, further admission on the Waiting List Slip, indicate when the date should be and return to reception staff 5. Admin staff must record the DNF outcome on Topas and re appoint as per clinician s instruction. Refer Topas Waiting List User Guide DNF for a routine appointment will reset the clock DNF for an urgent appointment will continue the clock. Staff must remember that an urgent patient s DNF will not reset the waiting time clock to zero and any further admission date must be booked with the patients waiting time guarantee. If a routine patient does not attend an out-patient appointment the waiting time clock will be reset to zero. If an urgent patient does not attend an urgent outpatient appointment it is considered unreasonable and clinically inappropriate to reset the clock for zero, therefore an urgent patients waiting time clock will continue and the patient will have to be offered a further appointment within their guarantee time. 6. Admin Staff should phone the patient and offer them another date for treatment within their Treatment Time Guarantee 7. A Wait Statement should be produced and sent to the patient which would show any adjustments to their Treatment Time Guarantee Example of Wait Statement at end of this SOP 67

68 Example of Wait Statement Example of Wait Statement: Mr John MacLeod 9 Hill Street Main Town Postcode Dear Mr MacLeod Wait Statement Waiting For Referred Specialty Priority Maximum Waiting Time In-Patient Admission Date Orthopaedic Routine 12 weeks (84 days) Key Dates: Date you were put on waiting list 01 Oct 2012 Your current admission date 03 Dec 2012 Dates which you are unavailable: 05 Nov Nov 2012 Patient Advised Work Commitment Current Guarantee Date 03 Jan 2013 Number of days from added to waiting list to admission Waiting time Calculations: Oct Dec 2012 Number of days waiting Oct Nov Nov Dec 2012 The number of days waiting and your guarantee date may be affected by any previous appointments /admission dates which you have declined, by moving an appointment/ admission date or not attending an arranged appointment/admission or being unavailable within the wait. Further information can be found in.. 68

69 1.7.7 Standard Operating Procedure 7 Project: Could Not Wait Operation Name & No. Project Reference: Kerry Originator: Ruth Anderson Wilson Date: 1 st October, 2012 Could Not Wait Page 1 of 2 Special Requirements Tools/Equipment A full set of TOPAS training notes can be found in Staffnet PC, TOPAS, Intranet, Access Policy, TOPAS User Guides, Clinical Outcome Crib Sheet, telephone, Printer. Issue No Main Operating Steps Key Points Explanation/Examples/Diagrams Could not Wait Out Patients 1. If a patient who has registered their arrival for an out-patient appointment indicates that they cannot wait for their appointment what should be recorded on Topas will vary depending on whether it is a reasonable or unreasonable length of wait. 2. If the wait has been less than 30 minutes then it is classed as unreasonable if the patient could not wait and CWU should be recorded on Topas CWU could not wait unreasonable, will reset the waiting time clock to zero as this is only a short delay and it is unreasonable that the patient could not wait. 69

70 3. The patient should be offered a further appointment within their waiting time guarantee (see Topas User Booking Guide) 4. If the wait has been more than 30 minutes then it is classed as reasonable if the patient could not wait and CWR should be recorded on Topas 5. The patient should be offered a further appointment within their waiting time guarantee (see Topas User Booking Guide) CWR could not wait reasonable will continue the waiting time clock as the delay was due to the late running of an appointment and the delay is much longer than the patient could reasonably be expected to wait. Staff must remember that in this instance the waiting time clock is continuing Script: Patient should be reminded that because they have waited less than 30 minutes, which is deemed unreasonable of them, then they may be returned to the waiting list and could potentially wait another 12 weeks for an outpatient appointment. 70

71 1.7.8 Standard Operating Procedure 8 Project: Commencing Treatment Time Guarantee Operation Name & No. Project Reference: Kerry Wilson Commencing Treatment Time Guarantee Originator: Ruth Anderson Date: 1 st October, 2012 Page 1 of 4 Special Requirements Tools/Equipm ent A full set of TOPAS training notes can be found in Staffnet PC, TOPAS, Intranet, Access Policy, telephone, Printer, Topas User Guides Issue No Main Operating Steps 1 Waiting List Entry: Admin staff should add the patient to the appropriate waiting list from the information recorded on the waiting list slip. 2 Acknowledge ment letter Key Points The clock start for TTG is the date when the clinician and patient agree to the treatment (which will be the date when the decision is made by the clinician to put the patient on the waiting list). For the vast majority of patients agreement will be the date of the outpatient appointment. It is therefore essential that there is no delay between the agreement to treat and the patient s waiting time clock starting. It is expected that all patients should be added to the waiting list within 5 days of the decision to treat, but it is essential that the appropriate waiting list date is entered into TOPAS From 1 st October, 2012 all patients who are added to an in-patient/day case waiting list will require an acknowledgement letter. 71 Explanation/Examples/Diagrams Please refer to Topas Waiting List User Guide Waiting List Entry Screen in Topas

72 TOPAS will produce an acknowledgement letter which should be printed and sent to the patients. Please see example of acknowledgement letter at end of this SOP. 3. Wait Statement: Topas will generate a wait statement for any changes that are made to the patients waiting time guarantee time e.g any patient advised unavailability. Patients should be sent a wait statement for all changes. Acknowledgement letter must be sent to advise the patient that they have been put on a waiting list and inform them of their treatment time guarantee. TOPAS will produce an acknowledgement letter which should be printed and sent to the patients In the interim period from 1 st October, 2012 until the acknowledgement letter is available on Topas (predicted to be November 2012) staff will have to manually input the treatment time start date and guarantee date on the letter. NHS Tayside has to advice patients of any changes to their wait. Patients who have been added to an inpatient/day case waiting list and have subsequently had an event which alters the waiting clock e.g. patient advised unavailability added will not receive a wait statement until this is available in the Topas release in November Please see example of Wait Statement at end of this SOP. 72

73 Example of Acknowledgement Letter: Treatment Time Start Date:.. Guarantee Date: Dear 73

74 Example of Wait Statement: Mr John MacLeod 9 Hill Street Main Town Postcode Dear Mr MacLeod Wait Statement Waiting For Referred Specialty Priority Maximum Waiting Time In-Patient Admission Date Orthopaedic Routine 12 weeks (84 days) Key Dates: Date you were put on waiting list 01 Oct 2012 Your current admission date 03 Dec 2012 Dates which you are unavailable: 05 Nov Nov 2012 Patient Advised Work Commitment Current Guarantee Date 03 Jan 2013 Waiting time Calculations: Number of days from added to waiting list to admission Oct Dec 2012 Number of days waiting Oct Nov Nov Dec 2012 The number of days waiting and your guarantee date may be affected by any previous appointments /admission dates which you have declined, by moving an appointment/ admission date or not attending an arranged appointment/admission or being unavailable within the wait. Further information can be found in.. 74

75 1.7.9 Standard Operating Procedure 9 Project: Booking Outwith Treatment Time Guarantee Operation Name & No. Project Reference: Kerry Wilson Booking Outwith Treatment Time Guarantee Originator: Ruth Anderson Date: 1 st October, 2012 Page 1 of 1 Special Requirements Tools/Equipment A full set of TOPAS training notes can be found in Staffnet PC, TOPAS, Intranet, Access Policy, telephone, Printer. Escalation Process SOPs for each service Issue No Main Operating Steps Key Points Explanation/Examples/Diagrams 1. On booking patient into appropriate list on TOPAS no slots available within Treatment Time Guarantee. Escalate to appropriate manager. 2. Patient sent letter providing an explanation of why NHS Tayside did not deliver the treatment time guarantee. All services must have individual escalation process SOP which clearly maps the escalation process up to and including Chief Executive This letter will be a generic letter with spaces for specific reasons for not delivering the treatment time guarantee. NHS Tayside must ensure that if it breaches the guarantee, then the patient is offered the next available appointment having regard to the patient s availability. In arranging the next available appointment NHS Tayside must not prioritise the start of the patient s treatment as this could be detrimental to another patient with a greater clinical need. NHS Tayside is also required to provide the patient with details of the advice and support available and on how to give feedback or raise a complaint. 75

76 Telephone Script: Booking an Appointment 1. Booking Staff Contacting Patient: Good morning / afternoon / evening (patient name) My name is (name) from the appointments team. We have received a referral from your GP/Consultant asking to give you an appointment for (name of specialty). Patient s Telephoning Booking Staff in Response to PFB Invitation/Reminder Letters: Good morning / afternoon / evening Ninewells / PRI / Stracathro Booking Office Ask patient for the ticket number (found on the top right of the letter) 2. Establishing Availability P The application of any advised unavailability can only be made at the request of the patient and must not be prompted by the Health Board Patient Advised Unavailability Patient Advised on Holiday Patient Advised Personal Commitment Patient Advised Work Commitment Patient Advised Carer Commitment Patient Advised Academic Commitment Patient Advised Jury Duty Patient Advised wishes named Consultant Patient Advised wishes specific location Advised Visiting Consultant Service patient wishes to be seen at next scheduled service within Board of residence Patient Advised following severe weather cancellation of Visiting consultant Services, wishes to be treated within local Health Board Patient Advised Indefinite Unavailability If yes - add social / medical unavailability recording the reason for the unavailability (from the list below) and also the start and likely end date (if known). Medical Unavailability Medical Other Medical Condition Medical - Indefinite Unavailability Medical Unavailability may only be applied on the advice of a Clinician. Record any relevant comments in comments box Record any relevant comments in comments box If No - Proceed to appointing (Making a Reasonable Offer) 3. Making a Reasonable Offer All patients must be offered a reasonable offer of appointment, i.e. up to 2 offers of appointment or admission 7 or more days notice given from the date the offer is made Exceptions: urgent appointments 3.1 Offer first available appointment within the patients waiting time standard. * Patient accepts first offer - Book appointment Patient declines first offer - Press the decline button to record the date that the first offer was declined. Proceed to Step

77 * If the first offer of appointment is within the 7 days outlined above and patient declines this date, this does not constitute a reasonable offer and a further reasonable offer should be made. If the patient accepts an offer within 7 days, this is will be considered as a reasonable offer. 3.2 Offer second next available appointment within the patients waiting time standard. Patient accepts second date - Book appointment Patient declines second offer - If the patient declines the second offer of appointment, it is important that you explain to the patient at this point that if they do not accept the second reasonable offer they will be returned to the beginning of the waiting list and could potentially wait another 12 weeks for an outpatient appointment, 9 weeks for inpatient admission or 4 weeks for diagnostic test. If a patient wishes to wait for a specific clinician or location Patient Advised Unavailability should be applied: The start date of the period of unavailability will be from the date that the patient has advised that they wish to wait for specific clinician/location The end date of the period of unavailability will be the date of the appointment. Patients must be told that this will affect the length of time that they will have to wait. Once the patient acknowledges the above and would still like to decline the second offer, press the decline button. The following screen will be displayed: This will automatically default to Keep on list and rest waiting time clock (further offers permitted). Select OK. The waiting times clock will reset to zero from the date of the conversation. The following screen will be displayed: Select OK Repeat the step to offer the patient another reasonable offer. 77

78 78

79 Telephone Script Cancel or Move Appointment (New Referral) 1. Good morning / afternoon / evening my name is (name) how can I help you? Details of all previous offers and whether they have been accepted or declined are displayed on the Booking Wizard screen. The dates are highlighted in blue (as outlined below): Clicking on any of the dates highlighted will provide details of all offers made, the dates the offers were made and the date the offers were declined. A. If the patient notifies you that they wish to change an appointment time and it has been agreed via Patient Focused Booking it is important that you explain to the patient that as they are requesting a change to a reasonable offer they will be returned to the beginning of the waiting list and could potentially wait another 12 weeks for an outpatient appointment, 9 weeks for inpatient admission or 4 weeks for diagnostic test. Topas will adjust waiting time clocks depending of whether the patient is Routine or Urgent. If a routine patient requests a change to their appointment then their waiting time clock will be reset to zero. If an urgent patient requests a change to their appointment then the clock would not be reset and the patient would have to be seen within current waiting time guarantee. Topas will adjust waiting time clocks depending of whether the patient is Routine or Urgent. B. If a patient notifies you that they wish to decline a written offer of appointment and this is the only offer they have received, then a second appointment should be offered within the patients waiting times standard. Once the patient acknowledges the potential impact on their waiting times and would still like to change the reasonable offer, press the decline button. The following screen will be displayed: This will automatically default to Keep on list and reset waiting time clock (further offers permitted). Select OK. The waiting times clock will reset to zero from the date of the conversation. The following screen will be displayed: 79 Select OK Reschedule - Record on TOPAS in Patient Appointment Screen moved by patient (MP). It is also important to add any periods of unavailability. Patient accepts second date - Book appointment Patient declines second offer - If the patient declines the second offer of appointment, it is important that you explain to the patient at this point that if they do not accept the second reasonable offer they will be returned to the beginning of the waiting list and could potentially wait another 12 weeks for an outpatient appointment, 9 weeks for inpatient admission or 4 weeks for diagnostic test.

80 If a patient wishes to wait for a specific clinician or location Patient Advised Unavailability should be applied: The start date of the period of unavailability will be when the earliest Waiting Time Standard or Treatment Time Guarantee would have otherwise come to an end. The end date of the period of unavailability will be the date of the appointment. Patients must be told that this will affect the length of time that they will have to wait. Once the patient acknowledges the above and would still like to decline the second offer, press the decline button. The following screen will be displayed: This will automatically default to Keep on list and rest waiting time clock (further offers permitted). Select OK. The waiting times clock will reset to zero from the date of the conversation. The following screen will be displayed: Select OK Repeat the step to offer the patient another reasonable offer. C. If a patient notifies you that they wish to cancel their appointment, this must be recorded in TOPAS. Cancel - Record on TOPAS in Patient Appointment Screen as cancelled by patient (CP) no further action is required. 80

81 81

82 SECTION 2 - CAPACITY AND SERVICE PLANNING CAPACITY MANAGEMENT & SERVICE PLANNING This section of the policy is to ensure that clear processes are in place where clinical service teams effectively plan and book clinical sessions. This will make sure that scheduled diagnostic, outpatient and inpatient and daycase capacity is maximised to meets the level of demand and sees and treats patients in clinical urgency, in turn thereafter and within waiting times standards. It is recognised that cancelling, reducing or changing agreed clinical schedules, particularly at short notice, has a significant impact on patients, staff across the organisation and involves significant rebooking and co-ordination of patient activity. 2.1 Consultant/Clinical Staff Leave Planning Clinical service teams are expected to have in place a clear understanding and detailed plans of how job plans, annual leave arrangements, study leave commitments, on-call arrangements, ward rounds, etc to cope with anticipated demand for inpatient, daycase and outpatient activity for planned and unplanned care. To comply with National Waiting Time Standards the Booking staff offer patient appointments 6 weeks prior to the outpatient clinic date with shorter timescales for diagnostics and inpatient and daycases. It is fundamental to this process that all agreed clinical sessions run as scheduled, not withstanding exceptional circumstances. In line with the Procedure for Authorisation and Recording of Annual Leave and CPD Leave for Medical & Dental Consultants, application for leave must be made timeously to allow for cover / cancellation where necessary. Sufficient notice must be given to ensure cover arrangements are made or 6 weeks notice of cancellation is given to patients (see appendix 1). Annual and Study Leave procedure for c Therefore, all requests for leave must be made in time to ensure that approval can be granted taking account for any cover required or approved cancellation. Booking teams require to be notified timely so that 6 weeks notice can be given to patients. 82

83 An extract from the Procedure confirms the requirements below: The Chief Operating Officer, Delivery Unit is responsible for ensuring procedures are in place to request, authorise and record applications for annual leave and continuing professional development leave. The Medical Director, Delivery Unit is responsible for ensuring that there is an appropriate scheme of delegation in respect of this procedure. The Medical Director is also responsible for ensuring that Standing Financial Instructions in respect of funding sources are adhered to. The Clinical Directors are responsible for authorising leave requests, excluding requests for continuing professional development leave and sabbatical leave from consultants, and maintaining robust records of requests, leave taken and cover / cancellation arrangements. The Clinical Directors can delegate authority to Clinical Leaders and / or Clinical Group Managers / Group Service Managers to approve leave. Where delegated authority has been given to Clinical Leaders and / or Clinical Group Managers / Service Managers, they are responsible for arrangements to adequately cover / cancel the staff s clinical duties and thereafter for authorising and recording the leave in accordance with the procedure. All medical and dental consultant staff are responsible for completing the annual leave documentation timeously to allow for cover / cancellation where necessary. Sufficient notice must be given to ensure cover arrangements are made or 6 weeks notice of cancellation is given to patients. All leave is only granted subject to approved arrangements having been made for his / her work to be done / cancelled during his / her absence and therefore it is important that staff appreciate that leave is granted subject to the exigencies of the service. Consultant staff are responsible for updating their personal annual leave cards. When leave is requested, the process outlined in the flow chart (see appendix 2) should be followed, approved by the Clinical Director and Clinical Service Manager and a clear and timeous instruction given to the booking teams. Where booking is undertaken within the clinical service team, there will be a requirement to nominate who this should be. Where workload is dependent upon other staff groups, e.g. Anaesthetists, staff in clinic areas, these will require modelling as part of the leave arrangements and agreeing within the Clinical Team. Although the above procedure extract applies to Medical and Dental Consultants, it is an integral part of this policy and applies to all clinical staff who undertake outpatient, diagnostic, inpatient and day case clinical sessions. 83

84 2.2 Notifying Changes to Outpatient Clinical Sessions Outpatient Clinical Session Changes/Reductions due to Leave Where it is essential to cancel clinical sessions as a result of exceptional circumstances, e.g. sickness, bereavement, carers leave, legal obligations, etc, all possible cover options should be considered. Clear instruction must be given to the booking team regarding the outpatient clinic or theatre session to which the cancelled patients should be moved to (see appendix 3). This may require additional clinical sessions to be set-up to ensure patients are seen within their patient personal guarantees. In these circumstances the clinical service team should also consider other cover arrangements rather than cancelling the clinical session Job Plan Changes to Outpatient Sessions As part of the Consultants Job Plan, all current clinic templates should be reviewed at least once per year. Any change in the clinic template should be agreed in consultation and agreement with the Clinical Services Manager and the Booking Service. Service capacity should be accurately reflected in the Patient Administration System (TOPAS) for outpatients and it is essential that clinic templates which are set up in TOPAS are agreed, communicated and implemented within the clinical service team and reflect the agreed capacity, e.g. frequency of the clinic, new & review and urgent & routine patient numbers, start & finish times and minutes required for each patient. There are two forms for confirming outpatient clinic schedules, one for setting up new clinics and one for changes to existing clinics (see appendices 4 & 5). It is recognised that the detail in the clinic templates will be a dynamic process which will reflect the changing needs of the clinical service, e.g. roles, staffing, case mix. Any change which results in reduced capacity will require to understood and be signed-off by the Clinical Services Manager. New outpatient attendees will be booked into the agreed outpatient clinic templates at a maximum of 6 weeks prior to the clinic date. As outlined in section above, scheduling should also take account of Job Plan, on-call and leave arrangements to ensure the effectiveness of patient pathways and Consultant/clinician specific work schedules. It will be the responsibility of the clinical service teams to ensure all booking of pre-outpatient appointment diagnostic testing is carried out prior to the patient attending for their outpatient appointment. To avoid waste, duplication and disruption to patients, ALL outpatient clinic template cancellations and changes should be agreed at least 6 weeks in advance of the scheduled clinic time. This will ensure the move does not result in the patient breaching their personal waiting time guarantee. Authorisation of any change in scheduled clinics should be notified immediately to the Booking 84

85 Service as the booking process commences 6 weeks prior to the patient s appointment. Appendix 5 should be completed for clinic changes/cancellation. There is an expectation that no clinics are cancelled at less than six weeks notice and Medical Records staff will be instructed not to cancel. If for any reason clinical staff are unable to attend the clinic it would be expected that they find appropriate cover. In the event of exceptional circumstances, where a clinic is required to be cancelled at short notice, then approval of the Associate Medical Director/General Manager must be sought. They will then notify the relevant booking staff. While six weeks is the minimum acceptable contractual time for cancellation, please remember that longer notice where possible further assists optimal scheduling of this valuable resource. 2.3 Notifying Changes to Diagnostics Sessions Radiology outpatient bookings are made to available appointment slots on a rota that is created prospectively around 3 to 4 weeks in advance of appointment slots. If for any reason (e.g. equipment failure, staff sickness or unplanned absences) appointments cannot go ahead then patients are rebooked to the first available appointment. Wherever possible, internal rearrangements are made to avoid cancellation. 2.4 Notifying Changes to Inpatient & DayCase Sessions Any changes to inpatient or daycase theatre sessions should be notified at least 6 weeks in advance except in exceptional circumstances. This is in line with the notification period for consultant leave. The change should be communicated by completing the Theatre Sessions Notification of Change Form (see appendix 6) and ing it to the theatre scheduling box (theatrescheduling.tayside@nhs.net). The reason for the change MUST be clearly communicated on this form. It is not sufficient, for example, to record surgeon not available. This form should also be completed to notify changes to theatre sessions e.g. change of session holder. On receipt of a cancellation notification the Theatre Manager will contact the Capacity Managers to offer the session to any other specialty where additional theatre capacity may be required. At this point the theatre session will be recorded as Pending for a period of one week. If there is no uptake within this time period the session will be cancelled and the Theatre Manager will record this on the Theatre Management System/Schedule. A flow chart of the process is attached in appendix 7. 85

86 SECTION 2b - TEMPLATES FOR REQUESTING LEAVE AND CHANGES TO CLINICAL SESSIONS APPENDIX 2 CANCELLATIONS/REDUCTIONS TO CLINICAL SESSIONS Patients to be given 6 weeks notice Prior to 6 weeks before clinic planned Clinician Unable to Deliver Planned Clinical Session Liaise with Waiting Times Co-ordinators Assess impact/risk) for New & Review Patients Diagnostics Inpatient & Day Case Consider Options E.g. Alternative Cover Additional Session another day Increase capacity of future session YES/NO impact on waiting time Leave Request sent (with impact/risk/options) to Clinical Director for approval or further discussion with colleagues regarding further options Not Approved clinical session runs as planned Approved Clinical Session Cancelled or Reduced No change to clinical session (cover arranged) Complete Cancellation/Reduction Form & send to nominated Booking Team Waiting Times Coordinator Advised to update clinic details 6 weeks notice Booking staff action clinical session change based on approved instruction, record reason for cancellation and give patients 6 weeks notice of appointment/admission change 86

87 APPENDIX 3 - OUTPATIENT CLINIC CANCELLATION/REDUCTION NOTIFICATION PLEASE NOTE: A MINIMUM OF 6 WEEKS NOTICE MUST BE GIVEN TO THE BOOKING SERVICE TO CANCEL/REDUCE AN OUT-PATIENT CLINIC. THIS FORM SHOULD BE COMPLETED FULLY AND SIGNED AS THIS COULD RESULT IN A DELAY IN THE CANCELLATION BEING ACTIONED. Consultant:. Specialty: Reason for Cancellation/Reduction: (Please tick relevant box) Absence from: to: Main Hospital:.. Short Notice (i.e. less than 6 weeks)*this has to be approved by the Associate Medical Director/General Manager Annual Leave Sick Leave On Call Study/ Duty Leave Additional Professional Leave Management Meeting No Cover Specify Below Other Specify Below Please Specify: Out-Patient Clinics Day Date Clinic Code Location AM/PM Instructions Signature of Applicant: Date Requested: Authorised by: Clinical Director/Clinical Service Manager or Associated Medical Director/General Manager (for short notice cancellations) Contact Details (Consultant s Secretary): Completed copies of this form must be distributed to: Relevant Appointments Office See attached Relevant Out-Patient Department, Senior Nurse Nurse Bank Office, Level 9, Ninewells Hospital 87

88 Distribution (please tick) Ninewells Hospital Perth Royal Infirmary Stracathro Hospital Kings Cross Hospital Dundee Dental Hospital Arbroath Infirmary Links Health Centre, Montrose Whitehills HCCC, Montrose St Margarets Auchterarder Crieff Cottage Hospital Aberfeldy Cottage Hospital Blairgowrie Cottage Hospital Pitlochry Community Hospital St Andrews Memorial Hospital For Booking Office use only: Date Received: Confirmation Sent To: Tear Off Slip To Be Returned To Speciality Clinic:... Cancellation Date: Actioned By: Date: 88

89 APPENDIX 4 - TOPAS CLINIC PROFILE CREATION To be completed, and authorised by the Clinical Services Manager for each new clinic creation. All forms completed must be returned to: TOPAS SUPPORT TEAM, MEDICAL RECORDS The creation of new clinics must be authorised by the Clinical Services Manager and the clinic profile agreed and signed off. If case notes are required, approval must be granted by the Medical Records Manager prior to the new clinic being set up. Once new clinics are approved, 6 weeks notice will be required prior to commencement date. Specialty/SubSpecialty Clinic Name Location/Clinic Reception Consultant and Attending Clinician Telephone Number (for appointments) Start and Finish Time AM / PM Frequency (wkly, fortntly, mthly, etc) Days clinic to run on (Mon, Tues, Wed.) Patient Letters Requirements (New / Return) Number of Slots NEW and Time Allocated Number of Slots RETURN and Time Allocated Casenotes required Approval from Med Recs Manager granted Start date of new clinic (6 weeks notice required) Yes / No Yes / No Additional notes/instructions - Slot Time Type N/R Priority R/U Requested by... Authorised by Contact No. Date Clinical Services Manager 89

90 APPENDIX 5 - TOPAS CLINIC PROFILE AMENDMENT The purpose of this form is to ensure a planned approach to clinic changes as part of job planning or service changes. This should be authorised by the Clinical Services Manager. All forms completed must be returned to: TOPAS SUPPORT TEAM, MEDICAL RECORDS Please note that patients must receive 6 weeks notice of any change to their appointments therefore to ensure that clinic profile changes do not impact on patients, therefore clinic amendments will commence 6 weeks from the request date. Current Clinic Code to be amended Specialty & Sub Specialty Clinic Name Location/Clinic Reception Consultant and Attending Clinician Telephone Number (for appointments) Change Requested: Start and Finish Time AM / PM Frequency (wkly, fortntly, mthly, etc) Days clinic to run on (Mon, Tues, Wed.) Number of Slots NEW and Time Allocated Number of Slots RETURN and Time Allocated Additional Casenotes required If Yes, approval from Medical Records Manager required Start date of amended / changed clinic (6 weeks Notice required) Yes / No Additional notes/instructions - Slot Time Type N/R Priority R/U Requested by... Authorised by Clinical Services Manager Contact No. Date 90

91 APPENDIX 6 THEATRE SESSION NOTIFICATION OF CHANGE FORM Date & Time of Session (AM, PM or All Day) Theatre Name (Number or Designation) Theatre Location (Suite / Hospital) Specialty Session Holder Reason for Change (annual leave, study leave, etc) Remarks / Additional Information (uplift of session from other specialty, etc) Completed by Date Completed & Sent Please complete and return to: theatrescheduling.tayside@nhs.net 91

92 APPENDIX 7 92

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