Patient Access Policy

Working together to make best use of specialist hospital services Patient Access Policy (Draft 8 May 2006) A policy for NHS Highland staff and patients May 2006

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CONTENTS Page 1. INTRODUCTION AND AIM OF THE POLICY 3 2. KEY PRINCIPLES 3 3. STRUCTURE OF WAITING LISTS 4 4. OUTPATIENT REFERRALS 4 4.1 Referrer Responsibilities 4.2 Hospital Responsibilities 4.3 Patient Responsibilities 5. OUTPATIENT WAITING LISTS 6 5.1 Receipt and Management of Referrals 5.2 New Outpatient Appointments 5.3 Return Appointments 5.4 Patient Focused Booking 6. ELECTIVE INPATIENT/DAY CASE WAITING LISTS 7 6.1 Additions to the Waiting List 6.2 Offer of an Admission Date 6.3 Periods of Unavailability for Admission 6.4 Hospital Cancellation of Admission 6.5 Patient Cancellation of Attendance 7 PATIENTS WHO DO NOT ATTEND (DNA) 9 8 NON URGENT TRANSFERS BETWEEN HEALTHCARE PROVIDERS 9 9. DIAGNOSTICS 9 APPENDICES APPENDIX 1 DNA POLICY APPENDIX 2 DRAFT LETTER: CANCELLATION OF ACTIVITY 3

1. INTRODUCTION AND AIM OF THE POLICY Across Scotland and in our area of NHS Highland, millions are spent on health care every year. It is the responsibility of local NHS Boards to use that money well, for the maximum benefit of patients. This is a responsibility that NHS Highland takes very seriously. An important aspect of this is how long patients have to wait to receive their treatment. Patients who have the most urgent clinical need should be seen most quickly. Everyone who waits for treatment must be communicated with clearly and dealt with timeously and fairly. This policy sets out NHS Highland s approach to managing the length of time that people have to wait for an outpatient or inpatient /day case appointment or for an appointment to assist in their diagnosis (such as a scan or an X-ray). There are certain types of clinic or areas of treatment that the Scottish Executive has set specific targets for. This policy concentrates on these particular areas. Over time the policy will develop to cover other areas that do not have government targets, but which we feel in Highland need to be addressed as the next priorities. 2. THE KEY PRINCIPLES IN MANAGING WAITING TIMES IN NHS HIGHLAND Clinical Need Patients will be treated on the basis of their clinical need i.e. some patients will be called to be seen more quickly than others because of the nature of their condition. Fairness Amongst patients who are judged by the Consultant to have the same clinical need, treatment will be arranged in chronological order, that is in the order of their date of referral. The exception is those who have the flexibility to accept a booking at short notice (a period of less than 3 weeks). Respect Staff and patients will treat each other with respect and courtesy at all times Professionalism All data held on patients will be confidential, timely, accurate and complete. Waiting list information will be routinely audited and validated by NHS Highland. Clarity Communication with patients will, at all times, be clear, informative and timely. It will be presented in a language or format that best suits the individual patient. Focus This policy will support the achievement of the national waiting times targets and patients will have a right to have these targets explained to them, for example through our website: www.nhshighland.scot.nhs.uk Preparation Staff involved in the implementation of this policy will have an opportunity to influence it and its further development, and will be trained in aspects of its administration 4

3. STRUCTURE OF WAITING LISTS Policy for Managing Inpatient and Outpatient Waiting Lists Waiting lists are maintained for patients waiting at different stages of their care pathway. Patients waiting for a new outpatient appointment and patients waiting for elective admission to hospital are managed in separate waiting lists. 3.1 Outpatient Waiting List This list contains all patients waiting for a new outpatient appointment, sometimes referred to as a first outpatient appointment. It is this wait that is relevant to the national waiting times target. The Outpatient Waiting List does not contain patients who have already been seen in outpatients and need to attend again for a return appointment. These patients are managed in a different way. 3.2 Admissions Waiting List There are 2 elements to the waiting list for those patients waiting for an elective admission. One element is the General Waiting List for patients waiting for new treatment and it is this wait for admission that is relevant for the national waiting times target. The second element is the Planned Repeat Waiting List for patients waiting to be recalled for further stages of treatment or investigation. These patients are not waiting for new treatment, only for planned continuation of treatment 4. OUTPATIENT REFERRALS 4.1 Referrer Responsibilities Everyone involved in the management of waiting times has a responsibility to make it as efficient as possible: 4.1.1 Referrers must provide accurate, timely and complete information within their referral. 4.1.2 Referrals should only be made if all other alternatives have been explored ie patient/clinical pathways have been followed. 4.1.3 To minimise waiting times and to enhance patient access to services, referrers are encouraged to make unnamed referrals (Dear Dr) unless there is a specialist requirement for a named consultant. 4.1.4 When referring children or adults who cannot understand or give consent for their own treatment, the referrer must provide details of who has the ability to act on behalf of the patient. 4.1.5 Referrers should identify any special communication requirements their patients may have and detail these on the letter. (eg literacy problems, need for BSL or other language interpreter). 4.1.6 At the time of the referral in addition to the patient s name and contact address, information should be supplied on: All relevant clinical information together with the referrer s assessment of the level of Clinical urgency. 5

The patient s availability eg are they known to be unavailable for given period(s) of time. When the referrers are aware that patients will be unavailable to be seen for a period of time, the referrer should either delay sending the referral until they know the patient is available or note the patient s unavailability period on the referral. The patient s CHI identifier The patient s willingness to be seen at short notice (within three weeks). 4.1.7 Referrers are required to ensure that all suspected cancer referrals are clearly marked as urgent. Where electronic methods of referral are available these must be used. 4.1.8 Wherever possible, referrals should be made electronically through SCI Gateway. 4.1.9 After a referral has been made, the referrer must inform the hospital if the patient no longer wishes to be seen. 4.1.10 The GP must inform hospital if the patient has died. 4.2 Patient Responsibilities (Patient responsibilities to be outlined within a general patient information leaflet) 4.2.1 Patients must inform the hospital of any changes to their name, address, telephone number or GP. 4.2.2 Patients should keep their appointment, and make every effort to arrive on time. 4.2.3 If the patient cannot attend, they should inform the hospital with as much notice as possible 4.2.4 Patients must inform their GP if their medical condition improves or deteriorates in a way which may affect their attendance. 4.2.5 Patients who no longer wish to have their outpatient appointment or admission, for whatever reason, must advise either their referrer or the hospital appointment office. 4.2.6 Patients should be aware that their outpatient appointment could be within any appropriate healthcare facility within the boundaries of NHS Highland. (NB Argyll & Bute CHP patients will be seen locally or in NHS Glasgow & Clyde.) 4..2.7 Patients who know that they will be unavailable for any periods of time (e.g. holiday or work commitments) and therefore will not be able to attend for an appointment or admission should inform the hospital appointments office. 4.3 Hospital Responsibilities Section 5 onwards of this policy provides full details of hospital responsibilities. 6

5. OUTPATIENT WAITING LISTS Policy for Managing Inpatient and Outpatient Waiting Lists 5.1 Receipt and Management of Referrals 5.1.1 The hospital record of all referrals must include the required Community Health Index (CHI) identifier, full demographic details, telephone numbers, any language or communications needs and any other information required on the referral template. 5.1.2 Referrals will be prioritised by the receiving Consultant according to clinical need based on clinical information included on the referral. Patients will be informed if the priority status of their referral has been changed. 5.1.3 Patients referred with suspected cancer will be treated as a priority. 5.1.4 The service will notify the referrer in writing if the referral has been redirected. For example, if a referral has been made and the skills of the Consultant does not match the particular needs of the patient, the Consultant will cross-refer to a colleague. 5.1.5 If the Consultant decides that a referral is avoidable, the Consultant will inform the referring clinician in writing of this decision and the reasons behind it. 5.2 New Outpatient Appointments 5.2.1 Referrals that are assessed as urgent by the consultants will be given priority. In these cases, where necessary, the outpatient staff telephone the patient to agree the appointment date/time and an appointment letter will be sent to confirm appointment details. 5.2.2 NHS Highland will ensure that for all routine new outpatient appointments, patients will be seen in line with national waiting times guidance. 5.2.3 If a patient is offered a short notice appointment (ie within three weeks) and declines the slot, this will not alter the patient s position on the waiting list. 5.2.4 A section within the appointment letter will remind patients of their responsibility to keep their appointment or inform the hospital if they cannot attend. 5.2.5 Where there is a clinical need, the General Practice will book Patient Transport to new/first appointments only. Booking will be in accordance with Scottish Ambulance Service protocols. 5.2.6 Clinics will not be cancelled with less than 6 weeks notice unless there are exceptional circumstances. Cancellations can only be made with the authority of the appropriate General Manager. 5.2.7 Where it is necessary to reduce or cancel a clinic, it is the responsibility of the clinician to review each list in order to ensure that all cancelled patients are re-booked within 7 days. 5.2.8 Where a patient cancels their appointment, one further appointment date will be agreed with them. Patients will be advised that a second cancellation may result in removal from the waiting list. 7

5.2.9 Hospital letters inviting patients for outpatient appointments will clearly state that if the patient fails to attend they may be referred back to their GP/referrer. 5.2.10 Patients who attend a clinic but cannot wait until their appointment because the clinic is running late will be offered another appointment, if possible before leaving the clinic. 5.3 Return Appointments 5.3.1 Patients will receive no more than 3 follow up appointments without their care being reviewed by a Consultant or Middle Grade Doctor. 5.3.2 Where there is a clinical need, Patient Transport for return appointments will be arranged by the hospital appointments office in line with Scottish Ambulance Service protocols. 5.4 Patient Focused Booking For clinics where patient focused booking has been implemented as an alternative way of booking out patient appointments, the following process applies: 5.4.1 An acknowledgment letter detailing approximate length of wait, if appropriate, and the arrangements for Patient Focused Booking will be sent to patient after vetting. 5.4.2 Patients will be invited by letter 5 weeks before their expected date of appointment to contact the Appointments Centre to agree an appointment. 5.4.3 An appointment letter and any related information will be sent confirming details of the appointment. 5.4.4 If the patient does not respond, a reminder letter will be sent inviting them again to contact the appointment centre and also informing them that if they do not respond they may be removed from the list and their GP/referrer notified. 5.4.5 If no response is received following the reminder letter being sent, the patient may be removed and a letter sent to the referring clinician and GP informing them of this decision. 6 ELECTIVE INPATIENT/DAY CASE WAITING LISTS 6.1 Additions to the Waiting List 6.1.1 The decision to add a patient to a waiting list must be made by a consultant, or by another health care professional e.g. specialist nurse, in accordance with protocols agreed by the consultant. 6.1.2 Patients must not be added to the Waiting List if they are not fit, ready and able to come in on the date the decision to admit is made. Patients who are not fit and ready should be returned to their GP s care for monitoring of their general health, and referred back to the hospital consultant once fit enough for the planned intervention in hospital. 6.1.3 If a patient has ongoing hospital investigations, then the consultant will reassess the patient s fitness for treatment once diagnostic or other investigations are completed and only then, will they be added to the list, if appropriate. 8

6.1.4 When a patient is added to a waiting list for admission to hospital, a letter will be sent confirming this to both the patient and the GP. 6.2 Offer of an Admission Date 6.2.1 Patients will be selected from the waiting list in order of clinical priority. 6.2.2 Those with the same level of clinical priority should be selected chronologically. 6.2.3 A minimum of 3 weeks notice will be given of admission date except where the patient has stated that they are able to come in at short notice. Three alternative admission dates will be offered. 6.2.4 Patients will be sent a To Come In letter that will require them to accept or decline the offer of admission either by telephone (to a named individual) or on an enclosed response slip. 6.2.5 Any patient information related to the intended procedure and/or any other information relating to their stay in hospital will be given to the patient in clinic or included with the admission letter. NB This section of the policy will be reviewed following the recommendations of the group considering the future management of patients not medically fit for surgery and the impact of pre-operative assessment. 6.3 Periods of Unavailability for Admission 6.3.1 At any one time a Consultant is likely to have a number of patients who have become unavailable for admission for clinical or social reasons. Periods of unavailability over 7 days will be recorded and deducted from the patient s calculated waiting time. 6.3.2 If there is no known end date to the patient s unavailability, the patient will be reviewed at 13 weeks. If the review still does not determine an end date to the unavailability, the responsible clinician will determine whether the patient should remain on the list or be removed and referred back to GP care. 6.3.3 The patient and GP will be contacted to inform them if the patient is to be removed from the waiting list.. 6.4 Hospital Cancellation of Admission 6.4.1 Where a hospital cancels an operation/procedure for non medical reasons on the day of admission or after the patient has been admitted, the patient should be given a re-arranged date within the relative waiting list target or sooner if possible. This should be noted on the Waiting list record to ensure that every effort is made to avoid cancellation of this patient s treatment again. 6.4.2 Where it is necessary to cancel an admission or to cancel patients from a theatre list, it is the responsibility of the Consultant to review each such event in order to ensure that all cancelled patients are re-booked within targets. 9

6.5 Patient Cancellation of Attendance 6.5.1 Where a patient cancels their first admission date, one further admission date will be agreed with them. Wherever possible, this admission date will be arranged within the week of cancellation. Patients will be advised that a second cancellation by them will result in their removal from the waiting list. 6.5.2 Where a patient cancels a second admission date they will (following agreement of the consultant) be removed from the waiting list and referred back to the referrer. 7 PATIENTS WHO DO NOT ATTEND (DNA) Patients who DNA will be managed as outlined in the Hospital DNA Policy (attached at Appendix 1) 7.1 Hospital letters inviting patients for outpatient appointments or admission should clearly state that if the patient fails to attend they may be referred back to their GP/referrer. 7.2 All patients who DNA should be reviewed by a consultant or consultant s nominee for a decision about future management. This decision should be recorded in the patient s notes. 7.3 All appropriate administrative checks will be made when a patient has failed to attend. If a patient is removed from the waiting list following a failure to attend, they will be informed via a letter which will be sent to both the patient and his/her GP. 8 NON URGENT TRANSFERS BETWEEN HEALTHCARE PROVIDERS 8.1 The transfer of any part of a patient s health care to other Health Board areas or to the private sector must always be with the consent of the patient, their referrer, and the transferring consultant. 8.2 If a patient does not wish to be transferred NHS Highland must ensure that the patient is admitted to the appropriate NHS Highland hospital in accordance with this policy, and national waiting times targets. 9. DIAGNOSTICS Still needs further work. 9.1 Introduction Radiology Department provides the following services: Diagnostic Imaging: 10

General Radiography, including Barium Studies, Routine and Special X-Rays CT and MRI scans Ultrasound Highland Breast Screening provides the following service: Mammography 9.2 Managing Referrals The departments will offer a flexible service, as follows: The Radiology Department provides a high quality, efficient and effective Radiology service to patients Comply with IRMER 2000 regulations. All requests are justified prior to examination. All patient referrals will be registered on the Radiology Management System. Patients not registered on PAS will be registered. 9.3 A&E Referrals Referral forms from A&E will be delivered to the department by hand The department will undertake investigations in priority order The department will work collaboratively with the A&E staff to ensure that patients are investigated promptly in order to reduce unnecessary delays in their treatment Unreported films will be returned with the patient to A&E to facilitate prompt treatment. Films should be returned to the Radiology Department for reporting at a later stage. 9.4 Managing Cancer Referrals Patients referred with suspected cancer will be managed in line with the national waiting time targets. Referrers are required to ensure that all suspected cancer referrals are referred urgently. 9.5 Patient Cancellations Patients who cancel their appointments will be offered an alternative date and time. 9.6 Patients who Do Not Attend for their Appointment (DNA) Patients who DNA will be managed as outlined in the Radiology DNA Policy. 11

APPENDIX 1 DNA POLICY Arrangement for dealing with DNA s vary throughout the area. It was agreed that NHS Highland should have a uniform DNA Policy. AIMS OF THE POLICY: 1. Reduce the number of DNA s 2. Design a uniform policy, which is understood by everybody involved in the process and where the GP and the patient are made aware of the outcome. 3. To retain the principle that the Consultant decides what should be done in an individual case. 4. To comply with the Scottish Exec letter to NHS Boards New Ways: Interim Guidance Including Definitions 30-03-05, which states that a patient will be deemed to DNA if a reasonable offer of appointment/admission has been offered, but the patient does not report for the appointment/admission with no further discussion. 5. It is important that the original information sent to the patient should point out that if he/she fails to attend, the consultant will decide whether a further appointment will be sent, and that if the consultant decides that no further appointment is to be sent, the GP will be notified and will be at liberty to re-refer. In meantime the patient s name will be removed from the waiting list. THE PROCESS Outpatients 1. At the end of each clinic session, the clinic receptionist will provide the Consultant or Deputy with the notes of the DNA s at that clinic. Should the Consultant prefer, the notes of the DNA s could be sent to his/her secretary for a later decision. 2. The Consultant will decide on clinical grounds whether to send the patient a further appointment. The patient should not receive a further appointment as a matter of routine. 3. The notes should be appropriately annotated indicating the Consultants decision. The position should also be recorded on the PAS. 4. If the patient is not to be given a further appointment the GP and the patient will be informed by letter leaving it open to the GP to re-refer the patient if necessary. Admissions 1. The ward receptionist / consultant s secretary will provide the notes of patients who have failed to turn up for in-patient / daycase admission to the consultant.

} 2. 3. As for Outpatients above 4. NB For diagnostic depts. the question has been raised as to whether it is the referring consultant or the consultant in the diagnostic dept who should decide whether to send a further appt. As different depts. provide different services, perhaps this could be resolved locally between the referring consultant and the consultant in the diagnostic dept.

NHS Highland Medical Director s Office Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ Telephone: 01463 70400 Fax: 01463 711322 Textphone users can contact us via Typetalk: Tel 0800 959598 www.show.scot.nhs.uk/nhshighland APPENDIX 2 Date: Your Ref: Our Ref: Enquiries to: Extension Direct Line: Email: 12 December 2005 JC/LM Lynda MacKay 5789 01463 705789 lynda.mackay@haht.scot.nhs.uk Dear CANCELLATION OF CLINICAL ACTIVITY Introduction At the recent Medical & Dental Bargaining Group it was agreed that although there is no mention of a requirement to give notice of annual leave, study leave, or special leave in doctors Terms and Conditions, it was desirable that wherever possible, six weeks notice should be given of the above. The reasons for such a voluntary agreement would be: To reduce the inconvenience for patients who have been given an appointment and which would have to be cancelled and re-arranged. To reduce the unnecessary and rather unpleasant extra work for our appointments staff who have to phone up individual patients to cancel their pre-arranged and sometimes mutually agreed appointments. It was suggested at the above meeting that a voluntary code be instigated along the following lines: Except in exceptional circumstances, no pre-arranged clinical commitment (op-dc-ip) be cancelled less than 6 weeks from the date of the event. Exceptional circumstances would include e.g. sick leave / court appearances / emergency situations but not annual leave / study leave or other predictable absences. Yours sincerely Dr John Cormack Associate Medical Director (Operations) Working with you to make Highland the healthy place to be Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3HG Chairman: Garry Coutts Chief Executive: Dr Roger Gibbins BA MBA PhD Highland NHS Board is the common name of Highland Health Board c:\documents and settings\scamp02.raigmore-ad\desktop\patient access policy draft 8.doc