Appointment Slot Issue Management in the NHS e-Referral Service Slot Polling not Matching Manual Booking Window NHS e-Referral Service Programme

Introduction This presentation illustrates some of the benefits of matching polling ranges to outpatient waiting times The guidance document ‘Managing and Minimising Appointment Slot Issues’, available from the Document Library link at www.digital.nhs.uk/referrals outlines some of the practical considerations when making this change, along with further strategies for managing Appointment Slot Issues

Scenario All Saints Hospitals NHS Trust is a large organisation with hospitals on four different sites, and is busy tightening up on its overall performance. As a rule, All Saints tries very hard to manage its capacity and demand, aiming to keep waiting times down to a maximum of 7 weeks. All services on the NHS e-Referral Service (e-RS) are therefore set to poll at 48 days. This works reasonably well in some specialties, and GPs and patients are able to book an appointment - albeit sometimes without a huge amount of choice. Some specialties and especially some clinics however are struggling to cope with the demand for their services. Colorectal is one such specialty. They have several clinical vacancies within the team that they are struggling to fill. Trust policy, however, dictates that colorectal services, like all others, poll at 48 days. The colorectal team are currently holding a waiting list of patients and these patients are eventually booked into appointments at an average of 9 weeks and 2 days. Because the manual booking window (65 days) does not match the service’s e-RS polling range (48 days), patients referred via e-RS are unable to book This is causing a lot of extra work for the trust.

Booking Process – slot poll not matching manual booking window GP, in consultation with the patient, makes decision to refer. Referral information is attached by the practice with 24 hours Patient contacts Telephone Appointment Line to make booking – no appointment available and ‘Defer to Provider’ selected. Patient told to expect contact from hospital within 14 days RTT Clock Start Appointments Clerk at All Saints sees UBRN on ASI worklist and contacts practice to request referral letter is faxed +1 day Practice is unhappy at the rework – letter has already been attached to e-RS. GP is unavailable to confirm letter and sign until next day. Referral letter faxed +2 days Referral is for a peripheral site. UBRN cancelled on e-RS and referral added to PAS. Referral letter added to batch for consultant to review, collected by courier and taken to the post room Referral delivered to medical secretary at peripheral site. Consultant informed that there are referrals to review, but is unable to review same day Appointments Clerk has not had triaged referral returned after 1 week and calls to chase. Consultant will be back at peripheral site later that week and will review then. +9 days Patient has not heard from provider and contacts Telephone Appointments Line again to be told that the referral has been cancelled. Patient told to contact GP or Hospital for more information. Patent contacts GP practice to complain. +14 days Consultant reviews referral, marks as ‘Routine’ and returns to medical secretary. All triaged referrals returned to post room Appointments Clerk receives reviewed referral, patient is sent partial booking letter inviting them to book their appointment 3 weeks Patient receives letter 2 days later and contacts the hospital to book. Appointment agreed for 6 weeks time. RTT Clock 9 weeks and 2 days at appointment

Booking Process – slot poll matches manual booking window GP, in consultation with the patient, makes decision to refer. Referral information is attached by the practice within 24 hours Patient contacts Telephone Appointment Line to make booking – next available appointment is 65 days away. Patient is happy to book this appointment. RTT Clock Start Referral information is available to the Trust via e-RS and is reviewed as normal ahead of the appointment. RTT Clock 9 weeks and 2 days at appointment. Trust has reduced admin Patient has not had to complain Practice Staff have not had to do rework to send referral information and not received complaint from patient