How to write and review an access policy in line with best practice for referral to treatment and cancer pathways July 2018
What is covered? Why is an access policy important? What is the purpose of an access policy Who should be involved in developing the policy? What should you include or exclude? What questions should the access policy address? When should you review it? What happens next? 2
Why is an access policy important? The access policy informs patients, relatives and staff of their rights and responsibilities and tells patients, what to expect from the trust. It is linked to the NHS Constitution (2010) and therefore to certain legal rights. It allows trusts and commissioners to describe their local approach to managing and sustaining shorter waiting times, as set out in the NHS Constitution in line with national guidance. 3
The NHS Constitution Everyone has the right (by law since 2010) to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible. The waiting times are described in the Handbook to the NHS Constitution (updated 2015). 4
The purpose of an Access Policy The purpose of the policy is to ensure all patients requiring access to outpatient appointments, diagnostics and elective inpatient or day case treatment are managed equitably and fairly and consistently, in line with national waiting time standards and the NHS Constitution. The policy: should be clear and unambiguous is designed to ensure the management of elective patient access to services is transparent, fair, equitable and managed according to clinical priorities. sets out the principles and rules for managing patients through their RTT, cancer and diagnostic pathways. applies to all clinical and administrative staff and services relating to elective patient access at the trust and gives staff the opportunity to understand the rules and their application. 5
Who should be involved in writing an access policy? The access policy should be produced for and by the local health community and agreed by representatives from these organisations or groups: commissioners patient representative(s) providers clinicians primary and secondary care Cancer Alliance 6
What should be included or excluded? The policy must be fair and equitable for all patients Trusts may consider if separate RTT and cancer access policies are needed or if a single elective access policy is most appropriate The policy should focus on getting patients treated, not leaving them waiting (you should not impose minimum waits) Patients must be treated in clinical priority order. Patients with the same clinical priority should be treated in date order (the longest waiting patients treated first) The policy should reflect the local population s requirements and ensure patients are treated in a way that is consistent with the NHS Constitution The policy must reflect the latest iteration of the Going Further on Cancer Waits documentation 7
What should be included? Overarching generic principles Elective care access system-wide governance structure Staff competency and compliance principles Roles and responsibilities Communication National RTT and cancer standards and rules RTT cancer diagnostic 8
What should be included? RTT pathway specific principles relating to: referral management booking first outpatient appointments clinic attendance and outcomes diagnostics therapies non-activity related clock events pre-operative assessment / unfit patients admitted waiting lists adding / scheduling admissions Patient-initiated delays/declining offers/thinking time bilateral procedures clock starts/clock stops/did not attends (DNAs) and cancellations Non-RTT related principles regarding: planned patients admitted and outpatient follow-ups diagnostics, ie straight to test 9
What should be included? Cancer pathway specific principles relating to: referral management booking first outpatient appointments direct to test pathways Clinic attendance and outcomes diagnostics active monitoring therapies non-activity related clock events pre-operative assessment / unfit patients admitted waiting lists adding / scheduling admissions processes for managing multiple DNAs upgrades/downgrades planned/surveillance patients admitted and outpatient follow-ups diagnostics turnaround times interplay between RTT, cancer and diagnostic standards and clocks inter-provider transfers 10
Some RTT issues to address How to implement the national rules around clock starts and clocks stops locally? How will the trust ensure patients best clinical interests are served at all times? When is it appropriate to begin active monitoring? How to manage patient choice locally, in a way that avoids use of any blanket rules? 11
And for cancer? What is a breach? How should escalation processes be managed? When is it appropriate to pause a clock? When to apply active monitoring for cancer patients? What is a minimum dataset and when is it used? Inter-provider transfer processes and timescales 12
When to review the policy? It should be reviewed and signed off annually by the trust/ clinical commissioning board, in public Earlier if: national rules change local health community rules change trust processes change Trusts should consider a patient-facing summary for easy patient review, setting out patient rights and FAQs 13 How to write and review an access policy in line with best practice for RTT and cancer pathways
How to review the policy? Tools available: Model access policy Access policy review tool 14
What happens next? Once agreed and signed off by all its authors, you need to circulate the policy. The trust should consider: launching the policy with training sessions that highlight the differences from the old policy communicating the policy across the local health community developing standard operating procedures (SOPs) for appointments/admission offers, DNA and cancellation management, patient tracking list action cards, for example introducing the policy as part of the trust induction programme annual mandatory access policy training for all appropriate staff groups (possibly as an online assessment) 15
What happens next? Publishing the policy on the trust s website Holding paper copies of the policy for those without internet access (ie with patient advice and liaison service (PALS) office, main outpatient department, main reception, etc) Publishing a short patient information leaflet highlighting key points Publishing in different formats for optimal accessibility ie other languages, braille, etc Monitoring the policy s implementation and provide training and support as appropriate for staff 16
What standard operating procedures are needed? Suggested standard operating procedures (SOPs) Outpatients Receipt of Referral Referral triage Booking first appointments Patient appointment cancellations and reschedules Attending and departing patients from clinic Booking Follow Up Appointments Clinic use Outpatient waiting list management Clinic changes Diagnostics Receipt of diagnostic requests Vetting diagnostic requests Booking diagnostic appointments Patient diagnostic appointment cancellations and reschedules Reporting on diagnostic requests Diagnostic waiting list management Pre-operative assessment (POA) Receipt of POA request POA triage Booking POA appointments Patient POA cancellations and reschedules Recording POA outcomes Pre-operative waiting list management Admitted Adding a patient to the admitted waiting list Recording periods of unavailability Offering and recording admission dates Admitting and discharging patients Elective admitted waiting list management Planned waiting list management Theatre use 17
Critical success factors Develop access policies with key stakeholders Clearly define standards and pathway timescales - including national and local standards Develop SOPs and action cards to operationalise the policy Clarify patients responsibilities and expectations as well as ensuring these are reinforced when contacting patients (in writing, over the phone or in person) Outline staff roles and responsibilities and escalation expectations Review access policies in response to changes in national and local guidance, with which they should comply 18
Critical success factors (2) Develop key performance indicators (following the standards outlined in the model access policy) Base role-specific KPIs on the principles in the access policy and specific aspects of the trusts SOPs. For example: All staff involved in the cancer pathway will be expected to undertake initial cancer waiting times training within the first three months of appointment to the trust. All relevant staff will have annual refresher cancer waiting times training. Patients are booked into first appointment by day X, etc Staff are correctly adding data to the patient administration system 19
Final considerations Link the access policy to other key trust documents RTT or cancer policy if separate documents overseas visitor policy commissioner approval/low priority procedure diagnostic pathways Link the access policy to the trust escalation policy Link pathways to the access policy Support understanding of time scales (Ref to first outpatient appointment (OPA), first OPA to decision to treat, etc) 20
Final considerations Remember planned/surveillance/post-treatment patients: Which patients are followed up as planned patients? What does the policy say about starting RTT clocks for these patients? How are planned lists managed and who monitors them? Which forum is used to ensure planned patients are reviewed in a timely manner? 21
Contact us: NHS Improvement Wellington House, 133-155 Waterloo Road, London, SE1 8UG 0300 123 2257 enquiries@improvement.nhs.uk improvement.nhs.uk @NHSImprovement This publication can be made available in a number of other formats on request. 22 NHS Improvement 2017 Publication code: XXXXXX