1. ‘Test your knowledge of New Ways’ Scenarios Workshop
Andy Carver and Sean Brennan New Ways National Event Beardmore Conference Centre 7th February 2007

2. A brief reminder New Ways of Defining and Measuring Waiting Times:
Guidance
Reasonable Offer
Could Not Attend
Did Not Attend
Unavailability

3. 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

4. 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 Or
Return to GP

5. 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

6. 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

7. ‘Test your knowledge of New Ways’ Scenarios

8. 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?
Yes No

9. A1 Reasonable offer
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

10. 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?
Yes No

11. A2 Reasonable offer
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

12. Q3 Reasonable Offer
How many potential dates are generally required for a
‘reasonable’ offer?
One
Two
Three
As many as locally available

13. 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

14. Q4 Reasonable Offer 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?
Yes No

15. A4 Reasonable Offer
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

16. 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?
Add to WL for surgery
Add to WL for surgery, start period of unavailability and arrange review in 13 weeks time
Refer to dietician and arrange surgical OP appt in 6 months
Refer back to GP with recommendation to re-refer once weight loss is achieved

17. 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

18. 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?
Refer back to GP with recommendation to re-refer once hypertension controlled
Record start of ‘medical unavailability’ and arrange review date within three months
Other

19. 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

20. Q7 Waiting Time Measurement
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?
At referral - 01/01/08
When written offer is made - 04/02/08
When patient contacted to decline offer - 08/02/08

21. A7 Waiting Time Measurement
At referral
Declining one appointment has no effect on measurement
of patient’s waiting time

22. Q8 Waiting Time Measurement
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

23. Q8 Waiting Time Measurement
From which date should the patient’s reported waiting time be
measured?
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

24. 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

25. Q9 Patient Focussed Booking
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?
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

26. 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

27. Q10 Unavailability 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?
From date of referral to date of admission
From date of offer to date of admission
From date of referral to date of admission minus 29 days of February

28. 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

29. Q11 Unavailability 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?
From date of referral to date of admission
From date of offer to date of admission
From date of referral to date of admission minus 12 days of unavailability

30. A11 Unavailability 1) From date of referral to date of admission
Short periods of unavailability <8 days each are ignored

31. Q12 Transition from current system
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?
Yes No

32. A12 Transition from current system
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

33. For more information on New Ways of Defining and Measuring Times: