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Reasonable Offers - Outpatient and Diagnostics

All patients offered outpatient (both new and follow-up) and diagnostic appointments must be given reasonable notice.

Where the patient does not attend the appointment or make contact to re-arrange, then the patient is not fulfilling their obligation to make themselves available for appointments and they can be discharged back to their GP. The Trust will use its discretion when managing such cases as it recognises there maybe exceptional circumstances for non-response such as in the case of carers or those that are considered vulnerable. When these circumstances are apparent, a clinical review prior to discharge may be undertaken (& where necessary in conjunction with the patient’s GP) to ensure appropriate safe care remains available to the patient.

Patients should be made aware of the Joint Access Policy at the time of referral, to reduce DNA problems and unavailability for appointments. The patient will be advised to return to their referring GP when they are ready and available to be reinstated to the outpatient waiting list. A new 18 week clock will then start.

 

Outpatient Appointment - Patient Cancellations and DNAs

Letters and/or other electronic information sent to patients confirming an outpatient appointment will clearly state the patient can only cancel and rearrange an outpatient appointment once, regardless of the referral method used. The 18 week clock continues to tick from the original date of referral. If the patient cancels for a second time then they may be discharged back to their GP so they can discuss their treatment options and the clock is stopped. However, the Trust will use its discretion when managing such cases as it recognises that there may be exceptional circumstances for multiple cancellations such as in the case of carers or those that are considered vulnerable also in cases where there is clinical risk to the patient e.g. suspected cancer. The Trust will utilise its discretion, where a clinical review prior to discharge may be undertaken (& where necessary in conjunction with the patient’s GP) to ensure appropriate safe care remains available to the patient.

National guidance states that patients who cancel their appointment in advance should not be considered as DNA’s and should not have their clocks nullified. If a patient cancels on the day it should be assumed that it was their intention to attend and they should be offered a further opportunity to rebook their appointment.

It is important for patients and their carers to be aware that multiple cancellations also impact the waiting times and availability of appointments and resources for other patients on top of further delaying their own treatment. It is advised that due consideration and planning be taken when accepting appointments such that any multiple cancellations are only for exceptional reasons.

The Trust aims to reduce the incidence of patients failing to attend appointments and acknowledges that it is best achieved by agreeing the date with the patient in advance.

The Trust also operates an automatic appointment reminder service in some specialties for new appointments to help reduce DNAs. If a patient fails to attend their appointment (new, follow-up or diagnostic) and it was clearly communicated with reasonable notice as per national guidance and this can be demonstrated the patient will be referred back to the care of their GP. Both patient and GP will be notified in writing ensuring the referring GP is aware and can action further management of the patient if necessary. This will stop the 18 week clock.

Surrey Safe Care outcome processes must be adhered to, thus ensuring the RTT pathway correctly reflects the outcome. The Trust will utilise its discretion, where a clinical review prior to discharge may be undertaken (& where necessary in conjunction with the patient’s GP) to ensure appropriate safe care remains available to the patient.

In extreme circumstances, or if the patient is vulnerable, or subject to safeguarding concerns and the clinician feels it is detrimental to the patient’s health if the appointment is not rebooked, then the patient must first be contacted to ascertain the reasons for DNA and ensure compliance to attend the rescheduled appointment.

The existing referral will continue on Surrey Safe Care and the referral date will be the original date used to determine the patients 18 week pathway. This process should only be applied once, if the patient fails to attend a second time they must be referred back to the care of their GP to ensure their GP is aware the patient has not attended and discuss further with the patient.

 

Outpatient Appointment - Hospital Cancellations

A minimum of 6 weeks’ notice is required from all clinicians, in all but exceptional circumstances, to cancel or reduce any outpatient or diagnostic sessions for reasons of annual, or study leave or on-call commitments. If it is necessary, in exceptional circumstances to cancel or reduce any outpatient session, the Service Manager for that specialty must discuss in person with the relevant clinician and agree re-provision of lost capacity to ensure patients are not disadvantaged and waiting time not increased. If no resolution is found then escalation to the Associate Director of Operations may be required and their approval must be sought if the resolution remains being the cancellation of the clinic.

All short notice (less than 6 week) clinic cancellations must be authorised in writing by the appropriate Associate Director of Operations. The outpatient appointment centre staff will not action any short notice cancellations without this authorisation.

If a patient’s appointment has to be rescheduled due to a hospital cancellation, the patient will be contacted to arrange an alternative appointment date and time.

Appointments must be made as close to the original appointment as possible. This is particularly important when patients need to re-attend for test results, or to review medication. The 18 week clock continues during this time.

 

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