‘Test your knowledge of New Ways’
Scenarios Workshop
Andy Carver and Sean Brennan
New Ways National Event
Beardmore Conference Centre
7th February 2007
A brief reminder
New Ways of Defining and Measuring Waiting Times:
Guidance
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Reasonable Offer
Could Not Attend
Did Not Attend
Unavailability
Reasonable offer
 Patients should be offered up to two dates for OP, IP, or DC
services - regardless of method of offer
 Both dates should be at least three weeks in advance and within
national WT standards
Except
 Urgent appointments – three week rule not relevant
 Infrequent services where only one appointment need be
offered e.g. to remote and rural areas
Could Not Attend
 If after a reasonable offer has been accepted, the patient
contacts service to cancel and reschedule appointment:
 The WT is reset to zero from the date of contact
 Patient made further reasonable offer
 If a patient then asks to reschedule again, the receiving
healthcare professional responsible decides whether the patient
is to:
 remain on list, in which case:
 WT is reset to zero from the date of the contact
 Patient made further reasonable offer
Or
 Return to GP
Did Not Attend
 If, after a reasonable offer has been accepted, the patient does
not attend
 The receiving healthcare professional responsible decides
whether the patient is to:
 Remain on list
 WT is reset to zero from the date of the appointment
 Patient made further reasonable offer
Or
 Return to GP
Unavailability
 Do not add to WL if no known end date to unavailability
 When unavailability occurs during waiting
 Record start date of unavailability
 Record end date of unavailability or date of review (<13
weeks)
 Periods of unavailability (>7 days) subtracted from waiting
time
 Avoid repeated periods of unavailability
 If end date not known at review then, unless clinically
inappropriate, patient should be removed from WL and
returned to GP care
‘Test your knowledge of New Ways’
Scenarios
Q1 Reasonable offer
A letter is sent to a patient offering them an appointment in
4 weeks time. The letter explains that they should phone the
hospital if this is not suitable
Is sending a letter offering one date (with >21 days notice) for
an appointment ‘allowed’ as part of making a reasonable
offer?
1)
2)
Yes
No
A1 Reasonable offer
1) Yes
If the patient accepts then by definition it is considered a
reasonable offer
If the patient does not accept the appointment, then there is
still a requirement to offer an additional date with > 21 days
notice
Q2 Reasonable offer
Is phoning a patient to offer a date for an appointment the
next week ‘allowed’ as part of making a reasonable offer?
1)
2)
Yes
No
A2 Reasonable offer
1)
Yes
If the patient accepts the appointment then by definition
it is considered a reasonable offer
If the patient does not accept the appointment, then
there is still a requirement to offer up to two additional
dates with > 21 days notice
Q3 Reasonable Offer
How many potential dates are generally required for a
‘reasonable’ offer?
1)
2)
3)
4)
One
Two
Three
As many as locally available
A3 Reasonable Offer
2) Two
A ‘reasonable offer’ requires a second date to be
offered if the first is not accepted by the patient
Exceptions to this rule:
Where there are infrequent services e.g. to remote and rural
areas, only one appointment need be offered
Q4 Reasonable Offer
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New OP referral received at hospital on 01/01/08
Hospital offer made in writing on 04/02/08
Appointment offered for 03/03/08
Patient declines appointment on 08/02/08
Hospital offers a short notice appointment on 15/02/08
Patient accepts and attends appointment on 15/02/08
Is the appointment offered for 15/02/08 a reasonable offer?
1) Yes
2) No
A4 Reasonable Offer
1) Yes
If the patient accepts then by definition it is considered
a reasonable offer
If the patient does not accept the appointment, then there
is still a requirement to offer an additional date with > 21 days
notice as the appointment offered for 15/02/08 only gave seven
days notice
Q5 Medical unavailability
Patient considered to need knee surgery but needs to
lose 15 kg to be fit for surgery
How should this be managed?
1) Add to WL for surgery
2) Add to WL for surgery, start period of unavailability and
arrange review in 13 weeks time
3) Refer to dietician and arrange surgical OP appt in 6 months
4) Refer back to GP with recommendation to re-refer once
weight loss is achieved
A5 Medical unavailability
There are two acceptable answers - 3) and 4)
3) Refer to dietician and arrange surgical OP appt in 6 months
4) Refer back to GP with recommendation to re-refer once
achieved weight loss
Answers 1) and 2) involve placing a patient on a WL who is unfit
to undergo surgery
Q6 Medical unavailability
Patient has been on WL for surgery but at pre-op
assessment found to be hypertensive and unfit for surgery.
How should this be managed?
1) Refer back to GP with recommendation to re-refer once
hypertension controlled
2) Record start of ‘medical unavailability’ and arrange review
date within three months
3) Other
A6 Medical unavailability
2) Record start of ‘medical unavailability’ and arrange review date
within three months
The answer 1) Refer back to GP with recommendation
to re-refer once hypertension controlled is also acceptable
The patient can be sent back to GP, however as they have
progressed to pre-op assessment it would be more appropriate
to record medical unavailability and keep them on the WL
Q7 Waiting Time Measurement
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New OP referral received at hospital on 01/01/08
Hospital offer made in writing on 04/02/08
Appointment offered for 03/03/08
Patient declines appointment on 08/02/08
Hospital offers appointment on 15/02/08
Patient accepts and attends appointment on 15/02/08
When did the patient’s waiting time ‘clock’ start?
1) At referral - 01/01/08
2) When written offer is made - 04/02/08
3) When patient contacted to decline offer - 08/02/08
A7 Waiting Time Measurement
1) At referral
Declining one appointment has no effect on measurement
of patient’s waiting time
Q8 Waiting Time Measurement
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New OP referred on 01/01/08
Written offer made on 05/02/08 for appt. on 27/02/08
Patient declines on 08/02/08
Written offer made on 11/02/08 for appt. on 03/03/08
Patient contacts to decline on 21/02/08
Clinician advises that not appropriate to return to GP
Patient phoned and made further offer on 22/02/08 for appt. on
18/03/08. Patient accepts and attends
Q8 Waiting Time Measurement
From which date should the patient’s reported waiting time be
measured?
1)
2)
3)
4)
5)
6)
At referral - 01/01/08
When the first offer was made - 05/02/08
When patient contacted to decline first offer – 08/02/08
When the second offer was made - 11/02/08
When patient contacted to decline second offer – 21/02/08
When the third offer made - 22/02/08
A8 Waiting Time Measurement
5) When patient contacted to decline second offer – 21/02/08
The waiting time ‘clock’ is reset to zero when a second
appointment is declined
Q9 Patient Focussed Booking
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New OP referred on 01/01/08
PFB invitation sent out on 31/01/08
Patient phones hospital on 04/02/08:
 Offered appointment on 28/02/08 which they declined
 Offered appointment on 03/03/08 which they declined
 Offered appointment on 04/03/08 which the patient accepts
and attends
From which date should the patient’s reported waiting time
be measured?
1)
2)
3)
4)
Date of referral - 01/01/08
Date patient declined second appointment - 04/02/08
First potential appt. date - 28/02/08
Second potential appt. date - 03/03/08
A9 Patient Focussed Booking
2) Date patient declined second appointment - 04/02/08
The patient subsequently accepted an appointment and
therefore the reported waiting time is measured from 04/02/08
to 04/03/08, the date the patient attended the appointment
Q10 Unavailability
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Day case added to WL 01/01/08
Patient notifies hospital that unavailable during all of February
Patient contacted on 03/03/08
Offered, accepts, and attends admission on 25/04/08
How is the patient’s reported waiting time calculated?
1) From date of referral to date of admission
2) From date of offer to date of admission
3) From date of referral to date of admission minus 29 days of
February
A10 Unavailability
3) From date of referral to date of admission minus 29 days of
February
The period of unavailability is subtracted from the
total time on the waiting list to give the total
waiting time
During their period of unavailability the patient was not
considered to be waiting
Q11 Unavailability
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Day case added to WL 01/01/08
Patient notifies hospital that unavailable for three separate
periods of 4 days
Offered, accepts, and attends admission on 02/05/08
How is reported waiting time calculated?
1) From date of referral to date of admission
2) From date of offer to date of admission
3) From date of referral to date of admission minus 12 days of
unavailability
A11 Unavailability
1) From date of referral to date of admission
Short periods of unavailability <8 days each are ignored
Q12 Transition from current system
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Inpatient added to waiting list on 30/07/07
The patient is still on list at 01/01/08 and does not have an ASC
At 01/01/08 the patient has waited 22 weeks
Has this patient breached the new 18-week waiting
time standard?
1) Yes
2) No
A12 Transition from current system
1) Yes
All patients waiting at 01/01/08 are covered by the new waiting
time standard
If a patient is added to the list prior to 28/08/07 they will have
breached by 01/01/08
For more information on New Ways of
Defining and Measuring Times:
www.newways.scot.nhs.uk