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Service access and waiting times policy

Contents

  1. Policy summary
  2. Introduction
  3. Purpose
  4. Scope
  5. Procedure or implementation
  6. Training implications
  7. Equality impact assessment screening
  8. Links to any other associated documents
  9. References
  10. Appendices

1 Policy summary

The access and waiting times policy details how the trust has adopted and adheres to national access and waiting times standards, including how the trust has extended these guidelines across all its services, even where they do not fall into the national scope.

Access and waiting times standards are important measures to ensure that the trust is performing efficiently and offering timely intervention to patients.

2 Introduction

The purpose of this policy is to state the arrangements for the management of waiting lists and to ensure patients receive timely, equitable access to treatment in line with national access standards and the NHS constitution. It includes the guidelines and procedures to ensure that waiting lists are managed effectively, and a high quality of service to patients is maintained and details the key principles that govern effective and reliable referral to treatment targets (RTTs) for patients referred to services provided by Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH). In England, under the NHS constitution (opens in new window), patients ‘have the right 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 NHS constitution sets out that patients should wait no longer than 18 weeks from GP referral to treatment.

There are also individual access targets for certain specialist services such as early interventions in psychosis and perinatal.

In addition to this, the NHS has set out plans in the five-year forward view for mental health (opens in new window) to improve waits across all age services.

This policy details the key principles that govern effective and reliable referral to treatment targets (RTTs) for patients referred to services provided by Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH).

The principles contained within this policy reflect the national requirements for RTTs and for consistency, these principles and definitions will be applied for all pathways in the organisation, whether these are determined to be within the scope of the national guidance or not.

Due to the diverse nature of the portfolio of the trust’s services, there is a broad range of waiting times targets across services both within national guidance and as part of locally commissioned pathways. These are summarised in appendix D and appendix E.

The trust has taken the decision to apply an internal waiting time target of 18 weeks to all of its services where no other standard applies in pursuance of its vision “leading the way with care” and its values to be reliable, progressive and caring and safe.

As per the national guidance for referral to treatment waits for consultant led services there will be zero tolerance of any wait over 65 weeks.

3 Purpose

The purpose of this policy is to ensure:

  • adherence to national and local requirements relating to service
    access
  • patients receive treatment in line with agreed access targets according to their clinical priority, with routine patients and those with the same clinical priority treated in chronological order
  • processes of referral, diagnosis and treatment are transparent to the public and to partner organisations and open to inspection, monitoring and audit
  • all care groups have systems in place to capture each stage of the relevant waiting time pathway in a timely manner, and clear lines of responsibility and accountability are outlined in respect of accuracy and reliability of waiting lists
  • the time patients spend on the waiting list is minimised to improve the quality of patient experience
  • the number of cancelled appointments for non-clinical reasons is
    minimised
  • patients maximise their right to patient choice in the care and treatment that they need
  • the number of appointments booked in consultation with patients or through direct patient booking service is increased, thereby minimising appointments where patients did not attend (DNAs), or was not brought (WNBs), cancellations and improving patient experience
  • all referrals, additions and removals from the waiting list will be made in accordance with national guidance. RTT national guidance (opens in new window)

To ensure consistent ways of working, this policy should underpin any other standard operating procedure (SOP) or local working instructions (LWI) that are in place across the trust where these are developed to respond to service specific requirements. There should therefore be no clauses within local operational policies that contradict the principles of this policy and where this is identified to be this case, this policy will be determined to supersede local instructions.

The document contains the following sections which can be detached for reference purposes:

  • applicable national targets and standards
  • trust pathways determined to meet the definition of consultant-led
  • treatment start checklist table by service type

4 Scope

The scope of the policy includes all RTT consultant led services as defined in appendix D.

5 Procedure or implementation

Good practice determines that a clear distinction is drawn between the roles of colleagues responsible for meeting targets, and those responsible for reporting on performance in addition to having in place up-to-date policies and procedures describing this distinction. Reliable, valid data collection systems and appropriate training for key colleagues is essential to the accuracy of referrals and waiting list information and management.

Further support and guidance relating to correct data entry and capture please refer to the clinical systems intranet page (staff access only) (opens in new window).

For corporate responsibilities please refer to the performance management framework.

5.1 Quick guide

5.1.1 Management of waiting lists

  • Ensure patients receive timely, equitable access to treatment in line with national access standards and the NHS constitution.
  • Ensure that waiting lists are managed effectively, and a high quality of service to patients is maintained

5.1.2 Referral to treatment targets (RTTs)

  • Ensure patients ‘have the right to access certain services commissioned by NHS bodies within maximum waiting times, or take all reasonable steps to offer a range of suitable alternative providers if this is not possible’.

5.1.3 Waiting times

  • The NHS constitution sets out that patients should wait no longer than 18 weeks from GP referral to treatment.
  • There will be zero tolerance of any wait over 65 weeks.

5.1.4 Specialist services

  • Individual access targets for certain specialist services such as early Interventions in psychosis and perinatal.

5.1.5 Good practice

  • A clear distinction is to be drawn between the roles of colleagues responsible for meeting targets, and those responsible for reporting on performance in addition to having in place up-to-date policies and procedures describing this distinction. Reliable, valid data collection systems and appropriate training for key colleagues

5.2 Clinical records

Intrinsic to the use of any clinical system and therefore waiting list management is accurate clinical record keeping. Refer to the link provided on overarching guidance on best practice:

In addition, the trust’s health informatics directorate will take all reasonable steps to configure the trust’s clinical system in a format that supports users with entry and service access management and monitoring.

This is to include mechanisms for notification to clinical colleagues and service and team managers in relation to errors and omissions within clinical records.

5.3 Fast track access to services, this will revert to 52 weeks from April 2024 onwards

The following cohorts of patients have been determined to have a right to fast track access to services delivered by the trust in accordance with national guidance and legislation:

  • armed forces veterans receive priority access to NHS community
    services, where this is known and for any conditions which are likely to be related to their service
  • looked after children
  • post-partum or expectant mothers requiring perinatal mental health services

5.4 Access and waiting times process

The following outlines the trust’s procedure for the management of waiting times.

As stated above, the principles contained within this policy reflect the national requirements for referral to treatment (RTT) pathways and for consistency, these principles and definitions will be applied for all pathways in the organisation, whether these pathways are determined to be within the scope of the national guidance or not.

5.5 Prior to accepting referrals

5.5.1 Management of referrals

Dependent on the service, the trust currently accepts referrals in the following formats:

  • phone
  • paper
  • electronic
  • walk in
  • text

Dependent on the service, the trust currently accepts referrals from the following sources:

  • healthcare professionals including prison in-reach services
  • voluntary sector
  • friends and family (open policy)
  • emergency services
  • schools
  • local authorities
  • individuals referring themselves for treatment
  • attorney appointed to act on behalf of individuals in relation to their health and welfare if the patient lacks capacity to make the referral themselves

All referrals must be date stamped upon initial receipt by the trust and all decisions made regarding the referral documented within the electronic patient record (EPR). They must then follow the agreed referral-processing route as outlined below.

The minimum criteria for written referral to be determined to ‘contain sufficient information:

  • patient name
  • date of birth
  • address and or contact phone number
  • reason for referral
  • urgency

All referrals meeting these criteria will be passed to operational colleague responsible for triaging referrals, who will make a decision regarding the referral and whether it is appropriate for the service based on agreed local working instructions.

Referrals that do not meet these criteria will be signposted to more appropriate services or returned to the referrer with an explanation.

5.5.2 Signposting

The clock does not stop if a provider rejects a referral, stating that their service is not appropriate for this patient. The provider must re-refer the patient to an appropriate service or transfer responsibility for the patient’s care back to their GP without delay.

5.5.3 What if it is not clinically appropriate to treat within the waiting time target?

In some cases, treatment within the waiting time target will not be possible for various clinical reasons. For instance:

  • if a series of tests must be done in sequence
  • where the patient and consultant have agreed that the patient should receive a second opinion which despite best efforts adds a critical delay
  • any patients for whom there is genuine clinical uncertainty about the diagnosis but where watchful waiting (and clock stop) is inappropriate

In such instances referrals should be accepted, and the clock should continue to run, and will be accounted for in the waiting time target tolerance.

5.5.4 Consultation and advice

Some of the trust’s services offer a consultation and advice service, prior to formal referrals being made for assessment or treatment, for example child and adolescent mental health services (CAMHS).

When referrals are received into these services, a waiting time clock will only start if it is evident at the point of the referral that the patient will require clinical treatment during their pathway. If a person is subsequently determined to require clinical treatment, a waiting time clock will start at the point that this clinical decision is reached.

5.5.5 Prisoners

All principles contained within this policy are applicable to prisoners. Delays to treatment incurred because of access to prison do not affect the recorded waiting time for the patient.

The trust will work with colleagues in prison services to minimise delays through clear and regular communication channels and by offering a choice of appointment.

5.6 Following acceptance of referral

5.6.1 Clock starts

A waiting time clock starts when any referrer permitted by the trust refers to:

  • a consultant led service, regardless of setting with the intention that the patient will be assessed and if appropriate, treated before responsibility is transferred back to the referring health professional or general practitioner
  • an interface, referral management or assessment service, which may result in an onward referral to a consultant led service before responsibility is transferred back to the referring health professional or general practitioner
  • an allied health professional (AHP) led service, regardless of setting with the intention that the patient will be assessed and if appropriate, treated before responsibility is transferred back to the referring health professional or general practitioner

A waiting time clock also starts upon:

  • a self-referral by a patient to the trust’s services, where these
    pathways have been agreed locally by commissioners and providers and once the referral is ratified by a care professional permitted to do so
  • when the provider receives a paper or electronic referral letter or electronic referral to any other trust service
  • where there is a single point of access (SPA), the clock will start when the referral is received by the SPA and not when it is received by the treatment team. The trust will however only determine that a referral has been received when it contains sufficient information for the referral to be processed by the organisation. In the event that a referral is received that does not contain sufficient information, the referral will be determined to be an inappropriate referral and returned to the referrer. Please refer to appendix F for clarification
  • for eating disorders services only; where a primary reason for referral is not recorded as suspected eating disorder, but this is identified during triage or single point of access, the clock start date should be the date of initial referral. However, if this is not suspected during triage but at a subsequent assessment then the date the clock starts should be when the suspicion is first raised. If a person is already in contact with mental health services, the clock should start when suspicion of ED is first raised (not backdated to their initial contact with the mental health service)
  • a new waiting time clock should start following completion of a
    consultant-led referral to treatment (RTT) period when:

    • when a patient becomes fit and ready for the second of a
      consultant-led bilateral procedure
    • upon the decision to start a substantively new or different
      treatment that does not already form part of that patient’s agreed care plan
    • when a patient is re-referred into a consultant-led; interface or
      referral management or assessment service as a new referral
    • when a decision to treat is made following a period of active
      monitoring

5.6.2 Management of waiting lists

Waiting lists will be managed based on the following principle:

  • patients receive treatment in line with agreed access targets according to their clinical priority, with routine patients and those with the same clinical priority treated in chronological order
  • patients should receive assessment or treatment in accordance with the waiting time standard for their pathway, provided at appendices D and E
  • an internal waiting time target of 18 weeks to all trust services where no other standard applies
  • there will be zero tolerance of any wait over 65 weeks

If a referral relates to one of the following patient cohorts, the referral will automatically qualify as high clinical priority:

  • armed forces veteran (for health problems caused by time in service)
  • looked after child
  • post-partum or expectant mothers for referrals for mental health
    services

5.7 Clock stops and disengagement

5.7.1 Clock stops

The clock stops when:

  • first definitive treatment begins (NB: service specific rules apply for early intervention, these are from the NHS website (opens in new window). This is an intervention intended to manage the patient’s disease, condition or injury. What constitutes first definitive treatment is a matter for clinical judgement, in consultation with others as appropriate
  • early intervention in psychosis (EIP) services only; patient accepted on to the caseload of an EIP service capable of providing a full package of NICE-recommended care AND allocated to and engaged with an EIP care coordinator. Further information is available at the NHS website (opens in new window)
  • for ‘non-treatment’, a waiting time clock stops when it is communicated to the patient, and subsequently their GP and or other referring practitioner without undue delay that:
    • a clinical decision had been made not to treat
    • a clinical decision has been made to embark on a period of watchful waiting or active monitoring
    • clinical decision is made to return the patient to primary care
    • the patient declines treatment having been offered it
    • refer to RDASH disengaging with services policy covering children and or young people and children and adult mental health services for further guidance

The following examples do not stop the clock:

  • consultant-to-consultant referrals where the underlying condition remains unchanged
  • making a specialist referral or a referral from one provider to another
  • patient DNAs or was not brought to any appointment post initial
    assessment and is not discharged back to primary care
  • patient choice to postpone or delay an appointment
  • patient or provider cancellation of the appointment (even when this is on the day of the appointment)
  • patient contacts where it is not clinically considered that treatment has commenced, for example assessment only appointments
  • a checklist to support clinical decision-making regarding treatment starts, is provided at appendix E

5.7.2 Did not attend (DNA) or no access visits

DNA and no access visits do not stop or pause the clock. Colleagues should refer to trust disengagement policies for further guidance on engagement and discharge.

5.7.3 Cancelled appointments or home visits

A cancelled or rearranged appointment, either patient-initiated or provider initiated will not in itself stop an RTT clock:

  • patient-initiated cancellations, if a patient cancels, rearranges or
    postpones their appointment, this has no effect on the RTT clock,
    which should continue to tick. Patients should not be discharged back to the referrer simply because they have cancelled or rearranged appointments; referral back should always be a clinical decision, based on the individual patient’s best clinical interest
  • provider-initiated cancellations- If a provider cancels an appointment at any point (even when this is on the day of the appointment) in the waiting time pathway, this has no effect on the waiting time. The clock should continue to tick

5.7.4 Patient opts out or delays treatment

If a patient is unsure about going ahead with treatment, then it can be recorded that a clock stop for active monitoring has been initiated by the patient and a new pathway will start when the patient decides they wish to proceed.

In this instance local monitoring systems need to be put in place to ensure that the patient is followed up in a timely manner.

In some instances, it may be appropriate to discharge the patient and refer back to their GP, where their ongoing care will be managed in primary care.

The department of health supports the patient’s right to choose a date at any point along the pathway even if this means they cannot be treated within the target number of weeks. There is a tolerance to allow for patient choice in national RTT waiting time targets.

5.8 Clinical record keeping and data quality

Intrinsic to the use of any clinical system and therefore waiting list
management is accurate clinical record keeping. The following pages provide overarching guidance on best practice in this respect:

In addition, the trust’s health informatics directorate will take all reasonable steps to configure the trust’s clinical system in a format that supports users with data entry and service access management and monitoring.

This is to include mechanisms for notification to clinical colleagues and service and team managers in relation to errors and omissions within clinical records.

5.9 Escalation process

When an issue with data quality or waiting times, compliance is detected by the trust’s corporate services this will be escalated to the service manager in the first instance for investigation. The issue will subsequently be escalated through the trust’s management structure as necessary and proportionate to the significance of the issue identified.

When an issue with data quality or waiting times, compliance is detected in operational services, this will be actioned in accordance with the quality assurance and performance management framework.

6 Training implications

There are no specific training needs in relation to this policy, but the following staff will need to be familiar with its contents and any other individual or group with a responsibility for implementing the contents of this policy). But the following colleagues will need to be familiar with its contents:

  • service managers
  • clinical colleagues
  • administration colleagues
  • contracts, performance and CQUIN team
  • Information and Quality team
  • any other individual or group with a responsibility for implementing the contents of this policy

As a trust policy, all colleagues need to be aware of the key points that the policy covers. Colleagues can be made aware through:

  • one to one meetings or supervision
  • local induction
  • team talk
  • communications daily emails

6.1 Dissemination

The effective implementation of this document will support openness and transparency. The trust will:

  • ensure all colleagues and stakeholders have access to a copy of this procedural document via the organisation’s website
  • communicate to colleagues any relevant action to be taken in respect of issues
  • ensure that relevant training programmes raise and sustain awareness of the importance of effective waiting list and service access management
  • this policy will form part of the NHS standard contracts with each of the trust’s main NHS commissioners

6.2 Training

The IT Training Team provide training and support on TPP SystmOne and Microsoft Office to all colleagues within the trust.

The following suite of training is available for colleagues in relation to the trust’s clinical systems and therefore service access management and monitoring:

  • TPP SystmOne
  • IT skills assessment (NHS Elite)
  • IT skills online (NHS IT Skills Pathway)
  • Microsoft Office

All colleagues will be offered relevant training commensurate with their duties and responsibilities, aligned to use of the clinical system. Please refer to section 1.5.

Colleagues requiring support should speak to their line manager in the first instance.

For queries please phone 01302 798118 or email itsupport.rdash@nhs.net.

7 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

7.1 Privacy, dignity and respect

The NHS constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).

7.1.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act 2005. (section 1).

No issues have been identified in relation to this policy

7.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individual’s capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all employees working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

7.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act 2005 (section 1).

No issues have been identified in relation to this policy

8 Links to any other associated documents

9 References

The following legislation and guidance has been taken into consideration in the development of this policy:

10 Appendices

10.1 Appendix A Responsibilities, accountabilities and duties

Good practice determines that a clear distinction is drawn between the roles of colleagues responsible for meeting targets, and those responsible for reporting on performance in addition to having in place up-to-date policies and procedures describing this distinction. Reliable, valid data collection systems and appropriate training for key colleagues is essential to the accuracy of referrals and waiting list information and management.

Further support is available on the intranet (staff access only) (opens in new window). For corporate responsibilities please refer to the framework for corporate and operational responsibilities.

The trust has a ‘duty of care’ and a ’duty of confidentiality’ to ensure that all aspects of healthcare record keeping are properly managed. The trust must adhere to the legislative, statutory, and good practice guidance requirements relating to healthcare records management.

The chief executive has overall accountability and responsibility for healthcare records within the trust. This function is delegated to the executive medical director and the executive director of nursing and allied health professionals, who are responsible for driving high quality standards of healthcare record keeping.

The trust’s executive medical director (and trust Caldicott guardian) plays a key role in ensuring that NHS and partner organisations comply with current national guidance and relevant legislation regarding the handling and safeguarding of ‘patient identifiable information’. The Caldicott guardian will advise employees on matters relating to the management of patient identifiable information, for example where issues such as the public interest conflicts with duties such as maintaining confidentiality.

Senior managers of the trust are responsible for the quality of the healthcare records that are generated by all trust employees to ensure patient safety and quality service delivery.

Head of information management and business intelligence will advise the trust on how to maintain an efficient and effective patient information system, which complies with all the data collections required within the NHS.

10.2 Appendix B Monitoring arrangements

10.2.1 Adherence to policy requirements

  • How: Update on compliance.
  • Who by: Head of contracting, performance and CQUIN.
  • Reported to: Data quality and performance improvement group.
  • Frequency: Monthly.

10.3 Appendix C Applicable national targets and standards

10.3.1 Current national waiting times targets, April 2022

10.3.1.1 18 weeks referral to treatment (RTT)
  • Operational standard of 92% of patients on incomplete pathways (yet to start treatment) are waiting no more than 18 weeks from referral.
10.3.1.2  Allied health professional referral to treatment
  • 92% of patients on incomplete pathways (yet to start treatment) are waiting no more than 18 weeks from referral.
10.3.1.3 Early Intervention in psychosis
  • 53% of people with a first episode of psychosis begin treatment with a NICE recommended package of care within 2 weeks of referral.
10.3.1.4 Improving access to psychological therapies, waiting time to begin treatment
  • 75% of patients to be seen within 6 weeks.
  • 95% of patients to be seen within 18 weeks.
10.3.1.5 Eating disorders
  • Classify the urgency of the case within 24 hours.
  • High risk cases, face to face assessment to be undertaken within 24 hours.
  • Urgent cases, national Institute for health and care excellence (NICE)-concordant treatment should start within a maximum of 1 week from first contact with a designated healthcare professional.
  • Routine case, national Institute for health and care excellence (NICE)-concordant treatment should start within a maximum of 4 weeks from first contact with a designated healthcare professional.
10.3.1.6 Adult and older people mental health
  • Referrals who require an urgent face to face mental health assessment who were seen within 4 hours % compliance (excludes memory services).
10.3.1.7 Community response
  • Overall 2-hour urgent community response (UCR) care contacts.

10.4 Appendix D Treatment start checklist table by service type

10.4.1 Consultant or AHP-Led definitions

10.4.1.1 Doncaster care group:
  • community health services

Pathway:

  • evergreen, consultant pathway target 92% waiting less than 18 weeks
  • evergreen AHP pathway, target 92% waiting less than 18 weeks
  • community podiatry new patient wait, target 92% waiting less than 18 weeks
  • community podiatry nail assessment, target 92% waiting less than 18 weeks
  • community podiatry nail surgery, target 92% waiting less than 18 weeks
  • community podiatry biomechanics, target 92% waiting less than 18 weeks
  • community podiatry rheumatology access time, target 92% waiting less than 18 weeks
  • community podiatry routine diabetes access, target 92% waiting less than 18 weeks
10.4.1.2 Doncaster care group:
  • community health services
  • learning disabilities services
  • mental health services

Pathway:

  • AHP occupational therapy, target 92% waiting
    less than 18 weeks
10.4.1.3 Rotherham care group:
  • learning disabilities services
  • mental health services

Pathway:

  • AHP physiotherapy, target 92% waiting less than 18 weeks

10.4.1.4 North Lincolnshire care group:

  • learning disabilities services
  • mental health services

Pathway:

  • AHP dietician, target 92% waiting less than 18 weeks

10.4.1.5 Children’s care group:

  • children’s mental health services

Pathway:

  • AHP speech and language therapy, target 92% waiting less than 18 weeks

10.4.1.6 Children’s care group:

  • children’s mental health services

Pathway:

  • eating disorders pathway

10.5 Appendix E Patient responsibility and allocation process

10.5.1 Adult or older adult CMHT

Pathway:

  • if applicable

Accepted treatments:

  • psychoeducation
  • crisis planning
  • initial care planning
  • coping strategies
  • initiation of medication
  • peer support worker interventions
  • signposting to third sector services
  • psychiatric assessment

10.5.2 Talking therapies

Talking Therapies monitors access to NICE recommended treatment start as shown within page 14 of the Talking Therapies manual (opens in new window).

This is where the saved appointment ‘consultation activity’ includes the word treatment:

  • assessment and treatment
  • review and treatment
  • treatment

Evidence treatments include offered by IAPT:

  • low intensity cognitive behavioural therapy
  • high intensity cognitive behavioural therapy (HICBT)
  • eye movement desensitisation and reprocessing (EMDR)
  • person-centred experiential therapy (PCET)
  • interpersonal therapy counselling
  • couples counselling for depression
  • therapy groups
  • workshops

10.5.3 EIP

Pathway:

  • first episode psychosis (FEP) at risk mental state (ARMS) extended assessment

Accepted treatments:

10.5.4 ASD or ADHD

Accepted treatments:

  • advising or signposting
  • physical or mental wellbeing observations and education
  • risk management strategies
  • crisis or contingency planning
  • recommendation for post diagnostic support
  • recommendation for prescribing or medication

10.5.5  Forensic community

Accepted treatments:

  • initial assessment guides acceptance or refusal of the referral
  • if refused recommendations provided to support individual
  • signposting
  • commence forensic risk management planning
  • positive behaviour support review commencement
  • assess for possible interventions required, practitioner led or psychology
  • consultation initiated if required for independent service providers
  • relational security and positive behaviour support training initiated for teams if required
  • forensic information training for colleague if required

10.5.6 Perinatal

Accepted treatments:

  • initial care planning
  • birth planning
  • crisis planning
  • coping strategies
  • psychoeducation
  • medication or prescribing awareness
  • prescribing medication
  • advice and signposting for patient and partner or family members
  • self help
  • referral to bonding and attachment groups delivered in service
  • referral for physical health check
  • advice and guidance around bonding and attachment
  • referral onto the psychology, occupational therapy, support worker, or nursery nurse pathway

10.5.7 CAMHS

Accepted treatments:

  • self help
  • coping strategies
  • cognitive behavioural therapy based information

10.5.8 Drug and alcohol

Accepted treatments:

  • advise information
  • welcome group
  • mandatory drug rehabilitation requirements or alcohol treatment requirement appointment
  • transfer of care for prison or out of area

10.5.9 Learning disability

Accepted treatments:

  • advising or signposting
  • recommendation for annual health check
  • physical observations and health education
  • risk management strategies
  • crisis or contingency planning
  • care Planning

10.5.10 Physical health

Pathway:

  • podiatry

Accepted treatments:

  • nail surgery
  • ulcer treatment

Pathway:

  • salt

Accepted treatments:

  • advice and guidance around dysphagia
  • communication plan

Pathway:

  • dietetics

Accepted treatments:

  • oral nutrition support (food first and oral nutritional supplements)
  • enteral nutrition support (permanent gastrostomy tubes)

Pathway:

  • physiotherapy

Accepted treatments:

  • advice
  • equipment provision
  • signposting
  • direct hands-on treatment, for example, mobility or transfer practice, walking aid provision, exercise plan

Pathway:

  • occupational therapy

Accepted treatments:

  • advice
  • equipment provision
  • signposting
  • direct hands-on treatment, for example, transfer practice, home exercise or task practice, activities of daily living practice

10.6 Appendix F Patient responsibility and allocation process

This flowchart has been designed to support services in understanding patient responsibility across the referral pathway. It is acknowledged that teams may require a protected ‘under assessment’ period to decide if a referral is appropriate for their service where it would not be appropriate to expect them to undertake crisis management or follow-up work during that assessment period. The referral options following triage are detailed below.

  • Undecided, recording a referral in for the sole purpose of obtaining further information to make a decision. The time period for this option will be locally agreed but should ideally not exceed 14 days. The accept or decline process should be followed thereafter.
  • Accept referral to caseload or under assessment, if accepting to caseload, allocate a staff member from the receiving team to alert services of where patient responsibility resides. If accepting for under assessment, the referring team or SPA (locally defined process) retain responsibility for the patient until the outcome of assessment. Additionally, mark status on the referral allocation screen as ‘under assessment’ and then accept or decline following outcome of assessment. If the referral is declined, the referral allocation ‘under assessment’ should be removed. The receiving team should then inform the referrer and patient of the outcome.
  • Decline, decline and inform the referrer of the outcome. Where a referral is accepted to caseload or for assessment, it is important that the referral allocation is updated appropriately to reflect which team holds responsibility for the patient during each stage of the pathway. This is of particular importance for teams that accept for assessment initially. By updating the referral allocation to “under assessment”, teams are informed that responsibility for the patient has not yet been accepted and therefore should not be contacted for follow-up work. If the receiving team subsequently accept the referral, allocation to a staff member should take place and that team now assumes patient responsibility. Effective use of the referral allocation functionality will enable staff to see more clearly the current responsibility status of a patient.

It would be reasonable to assume that where internal waitlists are operated, a triage of some kind has already taken place to decide that a patient can reside on a waitlist for an intervention. A further triage would take place if the patients level of need or risk increased in terms of assessment via SPA or crisis if out of hours or by the treatment team in normal working hours. If an ‘internal referral’ is indicated, both the referring and receiving team should agree a timeframe for which the referral will be actioned. If this timeframe is exceeded, the receiving team will assume patient responsibility. If the team decline the referral, then the decline process should be followed.

  1. Record incoming referral.
  2. Assess priority:
    • urgent emergency, contact SPA for duty triage.
  3. Routine, record outcome of referral.
  4. Undecided (if requiring further information to make decision):
    • accept referral, allocate to staff member from referral allocation screen. Team assumes responsibility for patient
    • decline referral, inform referrer of outcome
  5. Decline referral, inform referrer of outcome.
  6. Accept referral to caseload or under assessment:
    • allocate staff member from referral allocation screen, team assumes responsibility for patient
  7. Under assessment ( referring team or SPA retain responsibility for the patient until outcome of assessment).
  8. Mark status ‘under assessment’ from referral allocation screen and complete assessment:
    • accept, referral, allocate staff member from referral allocation screen, team assumes responsibility for patient
    • internal referral indicated following assessment, allocate to staff member from referral allocation screen. Referring team retains responsibility for patient until the receiving team have accepted. Where the receiving team operates a waiting list, both teams should agree a timeframe for which the referral will be actioned. If this timeframe is exceeded, the receiving team will assume patient responsibility. If the team decline the referral, then the decline process should be followed
    • decline referral and remove referral allocation, inform referrer and patient of outcome

Document control

  • Version: 2.
  • Unique reference number: 472.
  • Approved by: Clinical policies review and approval group.
  • Date approved: 5 September 2023.
  • Name of originator or author: Head of contracting, performance and CQUIN.
  • Name of responsible individual: Executive director of nursing and AHP.
  • Date issued: 14 September 2023.
  • Review date: 30 September 2026.
  • Target audience: All operational colleagues.
  • Description of change: Three year review.

Page last reviewed: November 15, 2024
Next review due: November 15, 2025

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