NHS Information Authority

Data Standards Programme

QM08 1

Central Return Form Guidance

QM08 - Out-patient First Attendances Provider

Contextual Overview

1. The Department and Regional Offices require summary details from NHS HEALTH CARE PROVIDER of out-patient activity covering all their sites, split between the various SPECIALTY FUNCTION CODE. The return provides performance management measures of waiting times and helps to identify those organisations who have failed to meet the standards of the Patient's Charter.

1. The Department and STRATEGIC HEALTH AUTHORITIES require summary details from NHS HEALTH CARE PROVIDER of out-patient activity covering all their sites, split between the various SPECIALTY FUNCTION CODE. The return provides performance management measures of waiting times and helps to identify those organisations who have failed to meet the standards of the NHS Plan.

2. The information is used to model out-patient activity and waiting times. It supports the NHS Performance Tables and the latest initiatives to reduce DNAs - PATIENT who do not attend for their appointments.

3. It is also used in Public Expenditure Survey (PES) negotiations, for the production of in-patient and out-patient modelling tools, risk analysis and for Departmental accountability.

4. The information on the return is published in the Quarterly Review, Annual Reports, in the statistical bulletin 'Waiting Times for First Out-patient Appointments in England' and in the book `Waiting Times for First Out-patient Appointments in England: Detailed Statistics'.

Completing the Return QM08 - Out-patient First Attendances: Provider

5. The central return QM08 is completed quarterly by NHS TRUST and PRIMARY CARE TRUST providing out-patient services on one or more sites. It includes all OUT-PATIENT ATTENDANCE CONSULTANT whether taking place within a CONSULTANT CLINIC SESSION or outside a session. The only proviso is that the PATIENT must have seen a CONSULTANT (or a doctor acting for the CONSULTANT) for examination or treatment. It also requires data on referrals, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE should be used to identify referrals to be included in the return.

3. The central return QM08 is completed quarterly by NHS TRUST and PRIMARY CARE TRUST providing out-patient services on one or more sites. It includes all OUT-PATIENT ATTENDANCE CONSULTANT whether taking place within a CONSULTANT CLINIC SESSION or outside a session. The only proviso is that the PATIENT must have seen a CONSULTANT (or a doctor acting for the CONSULTANT) for examination or treatment. It also requires data on referrals, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE should be used to identify referrals to be included in the return. Private patients waiting for treatment in NHS facilities are included in the return, provided that they meet the referral inclusion criterion. NHS patients waiting for treatment at private facilities under an agreement with an NHS Trust should also be counted in the return.

4. The return requires information on:

4. The return requires information on:

   • the total number of written GP REFERRAL REQUEST (with the WRITTEN REFERRAL REQUEST INDICATOR set to Yes) for a CONSULTANT OUT-PATIENT EPISODE in the quarter;
   
   
   • the total number of other REFERRAL REQUEST (written or verbal) for a CONSULTANT OUT-PATIENT EPISODE in the quarter.
   
   
   • for GP written referrals only: the length of time PATIENT seen in the quarter had to wait from receipt of a GP REFERRAL REQUEST to the date of the first OUT-PATIENT ATTENDANCE CONSULTANT, banded in weeks;
   
   
   • for GP written referrals only: the number of patients at the end of the quarter, who have yet to be seen for a first OUT-PATIENT APPOINTMENT CONSULTANT and have been waiting in excess of 13 to less than 17 weeks, 17 to less than 21 weeks, 21 to less than 26 weeks and 26 weeks and over following receipt of the GP REFERRAL REQUEST.

• the total number of written GP REFERRAL REQUEST (with the WRITTEN REFERRAL REQUEST INDICATOR set to Yes) for a CONSULTANT OUT-PATIENT EPISODE in the quarter;

5. The return also requires information on the number of PATIENTS seen for a first OUT-PATIENT APPOINTMENT during the quarter who had a booked appointment date.

6. the total number of other REFERRAL REQUEST (written or verbal) for a CONSULTANT OUT-PATIENT EPISODE in the quarter.

7. for GP written referrals only: the length of time PATIENT seen in the quarter had to wait from receipt of a GP REFERRAL REQUEST to the date of the first OUT-PATIENT ATTENDANCE CONSULTANT, banded in weeks;

8. for GP written referrals only: the number of patients at the end of the quarter, who have yet to be seen for a first OUT-PATIENT APPOINTMENT CONSULTANT and have been waiting in excess of 13 weeks and 26 weeks following receipt of the GP REFERRAL REQUEST.

9. The return relates to a three month period, the first quarter starting on 1 April and the last quarter ending on 31 March. All four quarterly returns require data collected AT SPECIALTY FUNCTION CODE level. Returns must be submitted by the fifteenth working day after the end of the quarter.

6. The return relates to a three month period, the first quarter starting on 1 April and the last quarter ending on 31 March. All four quarterly returns require data collected AT SPECIALTY FUNCTION CODE level. Returns must be submitted by the fifteenth working day after the end of the quarter.

7. Estimates based on sampling may be provided where complete information is not readily available. Guidance is published by the Patient's Charter and Waiting Times Analysis Section of the Department of Health.

QM08 2

Central Return Form Guidance

QM08 - Out-Patient First Attendances Provider

Specialty Function (column 2)

Specialty Function (column 2)

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP Written (column 3) and Other (column 4).

GP Referral Requests (written)

Number of referral requests for first Out-patient Appointments (columns 5 & 6)

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

Other referrals

3. This counts all first OUT-PATIENT APPOINTMENTS in the quarter, which have an APPOINTMENT BOOKING SYSTEM TYPE set to Full booking system, split between GP written (column 5) and Other (column 6).

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

• GP written referral requests;
4. Fully booked appointments are those where a patient has been seen on the date that they were originally booked as agreed with the patient. Therefore booked appointments following GP referral should not be greater than the sum of the patients seen during the quarter i.e. column 5 should be less than or equal to columns 7 to 12.

GP Referral Requests (written)

5. REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

6. self referrals;

5. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

Other referrals

6. referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
7. referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

All other sources of referral should be included, e.g:

• referral from an A & E Department;

6. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 7 to 16)

7. referral from a Consultant, other than in an A & E Department;
8. referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

9. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:
7. Columns 7-12 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

   less than four weeks;
   four weeks and over but less than 13 weeks;
   17 weeks and over but less than 21 weeks
   21 weeks and over but less than 26 weeks
   26 weeks and over.

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks;
26 weeks and over.

8. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

8. Columns 13 - 16 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, broken down by the length of wait. Waiting times are banded as:

   13 weeks and over but less than 17 weeks
   17 weeks and over but less than 21 weeks;
   21 weeks and over but less than 26 weeks;
   26 weeks and over.

9. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

10. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

    Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

11. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08 3

Central Return Form Guidance

QM08 - Out-Patient First Attendances: Provider - continued

Specialty Function (column 2)

Specialty Function (column 2)

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP Written (column 3) and Other (column 4).

Number of referral requests for first Out-patient Appointments (columns 5 & 6)

3. This counts all first OUT-PATIENT APPOINTMENT in the quarter, which have an APPOINTMENT BOOKING SYSTEM TYPE set to Full booking system, split between GP written (column 5) and Other (column 6).

4. Fully booked appointments are those where a patient has been seen on the date that they were originally booked as agreed with the patient. Therefore booked appointments following GP referral should not be greater than the sum of the patients seen during the quarter i.e. column 5 should be less than or equal to columns 7 to 12.

GP Referral Requests (written)

5. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

Other referrals

6. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

GP Written Referrals only (columns 7 to 16)

7. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

7. Columns 7-12 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;

less than four weeks
four weeks and over but less than 13 weeks; less four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks; 13 weeks and over but less than 17 weeks;
17 weeks and over but less than 21 weeks;
21 weeks and over but less than 26 weeks
26 weeks and over.

Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

8. Columns 13 - 16 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, broken down by the length of wait. Waiting times are banded as:

   13 weeks and over but less than 17 weeks;
   17 weeks and over but less than 21 weeks;
   21 weeks and over but less than 26 weeks
   26 weeks and over.

9. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

10. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

    Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

11. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08 4

Central Return Form Guidance

QM08 - Out-Patient First Attendances: Provider - continued

Specialty Function (column 2)

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP Written (column 3) and Other (column 4).

Number of referral requests for first Out-patient Appointments (columns 5 & 6)

3. This counts all first OUT-PATIENT APPOINTMENT in the quarter, which have an ADMISSION BOOKING SYSTEM TYPE set to Full booking system, split between GP written (column 5) and Other (column 6).

4. Fully booked appointments are those where a patient has been seen on the date that they were originally booked as agreed with the patient. Therefore booked appointments following GP referral should not be greater than the sum of the patients seen during the quarter i.e. column 5 should be less than or equal to columns 7 to 12.

GP Referral Requests (written)

5. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

Other referrals

6. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

GP Written Referrals only (columns 7 to 16)

7. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

7. Columns 7-12 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks; 13 weeks and over but less than 17 weeks;
17 weeks and over but less than 21 weeks;
21 weeks and over but less than 26 weeks;
26 weeks and over.

8. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

8. Columns 13 - 16 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, broken down by the length of wait. Waiting times are banded as:

   13 weeks and over but less than 17 weeks;
   17 weeks and over but less than 21 weeks;
   21 weeks and over but less than 26 weeks;
   26 weeks and over.

9. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

10. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

    Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

11. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08R 1

Central Return Form Guidance

QM08R - Out-patient First Attendances: Responsible Population Based

Contextual Overview

1. The Department and Regional Offices require an aggregate return from HEALTH AUTHORITY covering their responsible population's experience with consultant out-patient services, split between the various SPECIALTY FUNCTION CODE. The return provides performance management measures of waiting times.

1. The Department and STRATEGIC HEALTH AUTHORITIES require an aggregate return from PRIMARY CARE TRUSTS as commissioners covering their responsible population's experience with consultant out-patient services, split between the various SPECIALTY FUNCTION CODE. The return provides performance management measures of waiting times against standards of the NHS Plan.

2. It is also used in Public Expenditure Survey (PES) negotiations, for the production of in-patient and out-patient modelling tools, risk analysis and for Departmental accountability.

Completing the Return QM08R - Out-patient First Attendances: Responsible Population Based

3. The central return QM08R is completed quarterly by HEALTH AUTHORITY and is based on the population for which the Health Authority is responsible. This includes all patients registered with GPs who form part of PRIMARY CARE GROUP and PRIMARY CARE TRUST for which the Health Authority is responsible, including those who are not resident within the Health Authority's geographical area. If a patient waiting for admission to hospital does not have an NHS GP, the responsible Primary Care Group or Primary Care Trust is determined by the postcode of the patient's home. The Health Authority's geographical area is divided up among its Primary Care Groups and Primary Care Trusts for this purpose The responsible Health Authority is then determined from the Primary Care Group's or Primary Care Trust's line of accountability, as usual. PATIENT treated under out of area treatments (OATs) are exceptions who should be counted by the `main commissioner'. This is normally the HA with the highest value of Service Agreements with the NHS Trust.

2. The central return QM08R is completed quarterly by PRIMARY CARE TRUSTS (as commissioners) and is based on the population for which the PRIMARY CARE TRUST is responsible. This includes all patients registered with GPs who form part of PRIMARY CARE GROUP and PRIMARY CARE TRUST for which the PRIMARY CARE TRUST is responsible, including those who are not resident within the PRIMARY CARE TRUST's geographical area. If a patient waiting for admission to hospital does not have an NHS GP, the responsible Primary Care Group or Primary Care Trust is determined by the postcode of the patient's home. The PRIMARY CARE TRUST's geographical area is divided up among its Primary Care Groups and Primary Care Trusts for this purpose. The responsible PRIMARY CARE TRUST is then determined from the Primary Care Group's or Primary Care Trust's line of accountability, as usual. PATIENT treated under out of area treatments (OATs) are exceptions who should be counted by the `main commissioner'. This is normally the PCT with the highest value of Service Agreements with the NHS Trust. Private patients are excluded from this return; however, PATIENTS waiting for treatment at private facilities under an agreement with a PCT should be counted in QM08R.

3. QM08R requires information on:

3. QM08R requires information on:

   • the total number of written GP REFERRAL REQUEST (with the WRITTEN REFERRAL REQUEST INDICATOR set to Yes) for a CONSULTANT OUT-PATIENT EPISODE in the quarter;
   • the total number of other REFERRAL REQUEST (written or verbal) for a CONSULTANT OUT-PATIENT EPISODE in the quarter.
   • for GP written referrals only: the length of time PATIENT seen in the quarter had to wait from receipt of a GP REFERRAL REQUEST to the date of the first OUT-PATIENT ATTENDANCE CONSULTANT, banded in weeks;
   • for GP written referrals only: the number of patients at the end of the quarter, who have yet to be seen for a first OUT-PATIENT APPOINTMENT CONSULTANT and have been waiting in excess of 13 weeks to less than 17 weeks, 17 to less than 21 weeks, 21 to less than 26 weeks and 26 weeks and over following receipt of the GP REFERRAL REQUEST.

4. The return also requires information on the number of PATIENTS seen for a first OUT-PATIENT APPOINTMENTS appointment during the quarter who had a booked appointment date.

5. The return relates to a three month period, the first quarter starting on 1 April and the last quarter ending on 31 March. All four quarterly returns require data collected at SPECIALTY FUNCTION level. Returns must be submitted by 25 working day after the end of the quarter.

• The total number of written GP REFERRAL REQUEST (with the WRITTEN REFERRAL REQUEST INDICATOR set to Yes) for a CONSULTANT OUT-PATIENT EPISODE in the quarter;

6. the total number of other REFERRAL REQUEST (written or verbal) for a CONSULTANT OUT-PATIENT EPISODE in the quarter.

7. for GP written referrals only: the length of time PATIENT seen in the quarter had to wait from receipt of a GP REFERRAL REQUEST to the date of the first OUT-PATIENT ATTENDANCE CONSULTANT, banded in weeks;

8. for GP written referrals only: the number of patients at the end of the quarter, who have yet to be seen for a first OUT-PATIENT APPOINTMENT CONSULTANT and have been waiting in excess of 13 weeks and 26 weeks following receipt of the GP REFERRAL REQUEST.

The REFERRAL REQUEST RECEIVED DATE should be used to identify referrals to be included in the return.

9. The return relates to a three month period, the first quarter starting on 1 April and the last quarter ending on 31 March. All four quarterly returns require data collected at SPECIALTY FUNCTION level. Returns must be submitted by 25 working day after the end of the quarter.

10. Estimates based on sampling may be provided where complete information about a HEALTH AUTHORITY's responsible population is not readily available. Guidance is published by the Patient's Charter and Waiting Times Analysis Section of the Department of Health.

QM08R 2

Central Return Form Guidance

QM08R - Out-patient First Attendances: Responsible Population Based

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP written (column 3) and Other (column 4).

Number of referral requests for first Out-patient Appointments (columns 5 & 6)

3. This counts all first OUT-PATIENT APPOINTMENTS in the quarter, which have an APPOINTMENT BOOKING SYSTEM TYPE set to Full booking system, split between GP written (column 5) and Other (column 6).

GP Referral Requests (written)

4. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

4. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT The REFERRAL REQUEST RECEIVED DATE should be used to identify referrals to be included in the return.

Other referrals

5. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

GP Written Referrals only (columns 7 to 16)

6. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

6. Columns 7-12 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks; 13 weeks and over but less than 17 weeks;
17 weeks and over but less than 21 weeks;
21 weeks and over but less than 26 weeks;
26 weeks and over.

7. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. Columns 13 - 16 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, broken down by the length of wait. Waiting times are banded as:

   13 weeks and over but less than 17 weeks;
   17 weeks and over but less than 21 weeks;
   21 weeks and over but less than 26 weeks;
   26 weeks and over.

8. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

9. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

10. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08R 3

Central Return Form Guidance

QM08R - Out-patient First Attendances: Responsible Population Based - continued

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP written (column 3) and Other (column 4).

Number of referral requests for first Out-patient Appointments (columns 5 & 6)

3. This counts all first OUT-PATIENT APPOINTMENTS in the quarter, which have an APPOINTMENT BOOKING SYSTEM TYPE set to Full booking system, split between GP written (column 5) and Other (column 6).

GP Referral Requests (written)

4. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

4. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT The REFERRAL REQUEST RECEIVED DATE should be used to identify referrals to be included in the return.

Other referrals

5. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

GP Written Referrals only (columns 7 to 16)

6. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

6. Columns 7-12 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks; 13 weeks and over but less than 17 weeks;
26 weeks and over. 17 weeks and over but less than 21 weeks; 21 weeks and over but less than 26 weeks; 26 weeks and over.

7. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. Columns 13 - 16 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, broken down by the length of wait. Waiting times are banded as:

   13 weeks and over but less than 17 weeks;
   17 weeks and over but less than 21 weeks; 21 weeks and over but less than 26 weeks; 26 weeks and over.

8. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

9. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

10. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08R 4

Central Return Form Guidance

QM08R - Out-patient First Attendances: Responsible Population Based - continued

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP written (column 3) and Other (column 4).

Number of referral requests for first Out-patient Appointments (columns 5 & 6)

3. This counts all first OUT-PATIENT APPOINTMENT in the quarter, which have an APPOINTMENT BOOKING SYSTEM TYPE set to Full booking system, split between GP written (column 5) and Other (column 6).

GP Referral Requests (written)

4. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

4. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT The REFERRAL REQUEST RECEIVED DATE should be used to identify referrals to be included in the return.

Other referrals

5. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

GP Written Referrals only (columns 7 to 16)

6. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

6. Columns 7-12 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks; 13 weeks and over but less than 17 weeks;
17 weeks and over but less than 21 weeks;
21 weeks and over but less than 26 weeks;
26 weeks and over.

7. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. Columns 13 - 16 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, broken down by the length of wait. Waiting times are banded as:

   13 weeks and over but less than 17 weeks;
   17 weeks and over but less than 21 weeks;
   21 weeks and over but less than 26 weeks;
   26 weeks and over.

8. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

9. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

10. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

Please address enquiries about this DSCN to:-
Data Standards Team
NHS Information Authority
Aqueous II
Aston Cross
Rocky Lane
Birmingham
B6 5RQ

Tel: 0121 333 0333