Change Request
 
NHS Information Authority

Data Standards Programme

Reference: Change Request 360
Version No:1.4
Subject:DSCN 07/2003
Type of Change:Central Guidance
Effective Date:1 September 2003
Reason for Change:Change to Admitted & Out Patient Waiting Time Information. To refine existing waiting time rules to bring them into line with existing good practice within the NHS.

Background:

Clarification around the waiting time calculations and associated Central Return form text is out-lined in this DSCN to refine existing waiting time rules, to bring them into line with existing good practice within the NHS. This note states the minumum criteria necessary to demonstrate reasonableness.

Guidance on reasonableness for written and verbal offers of appointments and admission offers.

The main purpose of this note is to reinforce the existing guidance on waiting times, in particular to ensure that verbal offers of appointment are dealt with on a consistent basis throughout the service, and that this is brought in line with written offers of appointment.

Mark Morrison of the Acccess Delivery Branch, reinforced the existing guidance on measuring and recording waiting times in his letter 'Measuring and Recording Waiting Times' to the service on 13th August 2002. In this he described the spirit in which waiting times were to be reported, if there is ever any doubt. This described the spirit of the rules, which are about reasonableness to patients and honesty to the public.

Written offers - under traditional systems prior to the introduction of booking, patients would receive a written offer of appointment. A patient not accepting this offer would be deemed to have self deferred and the trust should reset the clock or the date of the proposed/declined date.

Verbal offers - the introduction of booking systems placed more emphasis on a flexible dialogue between the patient and the trust and for this to be verbal.

These waiting time changes are based around the following issues:

i) For a written appointment or admission offer to a patient to be deemed reasonable, the patient is to be offered an appointment or admission date with a minimum of three weeks notice

ii) In addition to the 3 week notice, for a verbal appointment or admission offer to a pateint to be deemed reasonable, the pateint is to be offered: - for inpatient admission - a minimum of two admission dates - for an outpatient appointmemt - an appointment on a minimum of two different dates.

Please note that no changes have been made to the current Central Returns to accommodate these changes and that they refer to appointments and admission offers only. Cancer Waiting Times guidance remains unchanged. Please also note that the refusal of all reasonable offers of appointments or admission dates should be counted as a self-deferral from the date of the first offered appointment/admission.

The advantage of implementing explicit guidance on 'reasonableness' is to give benefit to both patients and to service colleagues, it will help further to embed the policy of booking in core systems in the service, and to give greater clarity and consistency in this aspect of waiting times. Where they are not doing so already NHS Trusts should migrate to using the new guidance immediately.

The changes in this DSCN support the principle that the rules for calculating and reporting waiting times should be reasonable to patients. The 'NHS Social Care Bulletin' of 18th July 2002 highlighted that these changes would be made. The Department's Access Directorate Branch will be happy to provide advice on any issues raised by this change notice and can be contacted by e-mail at 'mb-waiting-times@doh.gsi.gov.uk'. General advice to the NHS on these issues can be found on the Department's Waiting Times Website (www.doh.gov.uk/waitingtimes), which includes a 'frequently asked questions' page.

Summary of changes:
 
Data Elements
APPOINTMENT DATE   Change to description
OFFERED FOR ADMISSION DATE   Change to description
 
Central Return Forms
QM08 2   Change guidance text
QM08 3   Change guidance text
QM08 4   Change guidance text
QM08R 2   Change guidance text
QM08R 3   Change guidance text
QM08R 4   Change guidance text
 
Supporting Information
CENTRAL RETURNS-WAITING TIME CALCULATIONS FOR KH07+QF01   Change to supporting information

Name:Kevin Shine
Date:8 July 2003
Sponsor:Department of Health

Note: Additions shown in highlighted with a blue background. Deletions are shown using strikeout.


APPOINTMENT DATE

Change to Data Element: change to description

Format/length: n8 - ccyymmdd
HES item:
National Codes:
Default Codes:

Notes:
For appointments for a FIRST ATTENDANCE with a CONSULTANT; if a PATIENT indicates that he/she is unable to take up a reasonable telephone or written offer of an appointment, the refusal should be counted as a self-deferral, and the waiting time calculation is counted from the first offered appointment date.

For a verbal offer to be deemed reasonable, the patient is to be offered a minimum of two appointments on different days, with at least three weeks notice before the first offered appointment.

For a written offer to be deemed reasonable, the patient is to be offered an appointment date with a minimum of three weeks notice.



This data element is also known by these names:
ContextAlias
pluralAPPOINTMENT DATES


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OFFERED FOR ADMISSION DATE

Change to Data Element: change to description

Format/length: n8 - ccyymmdd
HES item:
National Codes:
Default Codes:

Notes:
The OFFER OF ADMISSION is a formal offer in writing of a date of admission, usually referred to as the ‚¨‹to come in date'. A telephoned offer of admission should not normally be recorded as a formal offer. Usually telephoned offers are confirmed by formal written offers, but in cases when a telephoned offer is made shortly before or, exceptionally, on the day of admission, there may not be time for this. A telephone offer made at short notice which is accepted should be regarded as formal. However, if a PATIENT indicates that he/she is unable to take up a telephone offer, the refusal should not be counted as a self-deferral. The date offered for admission to hospital to start a HOSPITAL PROVIDER SPELL.

The Guidelines issued by the Royal College of Surgeons recommend that admission letters should give PATIENTS good notice of the admission date and should normally reach the PATIENT a minimum of two weeks before the intended date of admission. The NHS Waiting Times Good Practice Guide advises that six weeks notice be given to PATIENTS. It is recognised, however, that this may not always be possible. If a PATIENT indicates that he/she is unable to take up a reasonable telephone or written offer, the refusal should be counted as a self-deferral, and the waiting time calculation is counted from the first offered admission date.

For a verbal offer to be deemed reasonable, the patient is to be offered a minimum of two admission dates, with at least three weeks notice before the first of these offered admission dates.

For a written offer to be deemed reasonable, the patient is to be offered an admission date with a minimum of three weeks notice.



This data element is also known by these names:
ContextAlias
pluralOFFERED FOR ADMISSION DATES


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QM08 2

Change to Central Return Form: Change guidance text

Central Return Form Guidance

QM08 - Out-Patient First Attendances Provider

    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)

  1. This counts all REFERRAL REQUESTS 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)

  1. 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).

  1. 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)

  1. A count of written referrals from GENERAL PRACTITIONERS, whether doctors or dentists, is required. These are GP REFERRAL REQUESTS which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUESTS 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

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

    • GP written referral requests;
    • REFERRAL REQUESTS 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 REQUESTS 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)

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. For patients who refuse a reasonable appointment, the waiting time is from the first offered appointment to the date when the patient is seen, or the date of the return. For a verbal appointment offer to be deemed reasonable, the patient is to be offered a minimum of two appointments on different days, with at least three weeks notice before the first offered appointment.

    For a written appointment offer to be deemed reasonable, the patient is to be offered an appointment with a minimum of three weeks notice

    For patients 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.

  1. 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.


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QM08 3

Change to Central Return Form: Change guidance text

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)

  1. This counts all REFERRAL REQUESTS 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)

  1. 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).

  1. 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)

  1. A count of written referrals from GENERAL PRACTITIONERS, whether doctors or dentists, is required. These are GP REFERRAL REQUESTS which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUESTS to CONSULTANTS 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

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

    • GP written referral requests;
    • REFERRAL REQUESTS 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 REQUESTS 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 7 to 16)

  1. 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 17 weeks;
    17 weeks and over but less than 21 weeks;
    21 weeks and over but less than 26 weeks;
    26 weeks and over.

  1. 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.

  1. 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.

  1. 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.

  1. For patients who refuse a reasonable appointment, the waiting time is from the first offered appointment to the date when the patient is seen, or the date of the return. For a verbal appointment offer to be deemed reasonable, the patient is to be offered a minimum of two appointments on different days, with at least three weeks notice before the first offered appointment.

    For a written appointment offer to be deemed reasonable, the patient is to be offered an appointment with a minimum of three weeks notice

    For patients 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.

  1. 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.


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QM08 4

Change to Central Return Form: Change guidance text

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)

  1. This counts all REFERRAL REQUESTS 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)

  1. This counts all first OUT-PATIENT APPOINTMENTS 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).

  1. 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)

  1. A count of written referrals from GP REFERRAL REQUESTS 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

  1. 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 REQUESTS 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 REQUESTS 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 7 to 16)

  1. 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 17 weeks;
    17 weeks and over but less than 21 weeks;
    21 weeks and over but less than 26 weeks;
    26 weeks and over.

  1. 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.

  1. 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.

  1. 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.

  1. For patients who refuse a reasonable appointment, the waiting time is from the first offered appointment to the date when the patient is seen, or the date of the return. For a verbal appointment offer to be deemed reasonable, the patient is to be offered a minimum of two appointments on different days, with at least three weeks notice before the first offered appointment.

    For a written appointment offer to be deemed reasonable, the patient is to be offered an appointment with a minimum of three weeks notice

    For patients 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.

  1. 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.


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QM08R 2

Change to Central Return Form: Change guidance text

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)

  1. This counts all REFERRAL REQUESTS 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)

  1. 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)

  1. A count of written referrals from GENERAL PRACTITIONERS, whether doctors or dentists, is required. These are GP REFERRAL REQUESTS which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUESTS 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

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

    • GP written referral requests;
    • REFERRAL REQUESTS 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 7 to 16)

  1. 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 17 weeks;
    17 weeks and over but less than 21 weeks;
    21 weeks and over but less than 26 weeks;
    26 weeks and over.

  1. 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.

  1. 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.

  1. 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.

  1. For patients who refuse a reasonable appointment, the waiting time is from the first offered appointment to the date when the patient is seen, or the date of the return. For a verbal appointment offer to be deemed reasonable, the patient is to be offered a minimum of two appointments on different days, with at least three weeks notice before the first offered appointment.

    For a written appointment offer to be deemed reasonable, the patient is to be offered an appointment with a minimum of three weeks notice

    For patients 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.

  1. 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.


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QM08R 3

Change to Central Return Form: Change guidance text

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)

  1. This counts all REFERRAL REQUESTS 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)

  1. 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)

  1. A count of written referrals from GENERAL PRACTITIONERS, whether doctors or dentists, is required. These are GP REFERRAL REQUESTS which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUESTS to CONSULTANTS 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

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

    • GP written referral requests;
    • REFERRAL REQUESTS 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 REQUESTS 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 7 to 16)

  1. 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 17 weeks;
    17 weeks and over but less than 21 weeks;
    21 weeks and over but less than 26 weeks;
    26 weeks and over.

  1. 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.

  1. 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.

  1. 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.

  1. For patients who refuse a reasonable appointment, the waiting time is from the first offered appointment to the date when the patient is seen, or the date of the return. For a verbal appointment offer to be deemed reasonable, the patient is to be offered a minimum of two appointments on different days, with at least three weeks notice before the first offered appointment.

    For a written appointment offer to be deemed reasonable, the patient is to be offered an appointment with a minimum of three weeks notice

    For patients 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.

  1. 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.


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QM08R 4

Change to Central Return Form: Change guidance text

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)

  1. This counts all REFERRAL REQUESTS 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)
  1. 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)

  1. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUESTS which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUESTS 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

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

    • GP written referral requests;
    • REFERRAL REQUESTS 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 REQUESTS 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 7 to 16)

  1. 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 17 weeks;
    17 weeks and over but less than 21 weeks;
    21 weeks and over but less than 26 weeks;
    26 weeks and over.

  1. 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.

  1. 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.

  1. 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.

  1. For patients who refuse a reasonable appointment, the waiting time is from the first offered appointment to the date when the patient is seen, or the date of the return. For a verbal appointment offer to be deemed reasonable, the patient is to be offered a minimum of two appointments on different days, with at least three weeks notice before the first offered appointment.

    For a written appointment offer to be deemed reasonable, the patient is to be offered an appointment with a minimum of three weeks notice

    For patients 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.

  1. 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.


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CENTRAL RETURNS-WAITING TIME CALCULATIONS FOR KH07+QF01

Change to Supporting Information: Change to supporting information

CENTRAL RETURNS

Central Returns

Waiting Time Calculations for KH07 and QF01

The following table provides a comparison of the waiting time calculations for Central Returns KH07 and QF01.

Please note that the Patient's charter column has been removed given that the Patient's Charter has now been replaced by "Your Guide to the NHS". However, the collection of the Patient's Original Decision To Admit continues to be an important performance management tool. Refer to "Your Guide to the NHS" for details of any new requirements.

Waiting List Event Calculation needed for KH07 and QF01
Original Decision To Admit (DTA)

The DTA is the DECIDED TO ADMIT DATE
Record DTA as start date
Patient on waiting list  
Patient is transferred to another provider. Count from DTA for new provider
Patient is unavailable for treatment (suspended) and offer of admission cannot be made for that period. Omit from KH07/QF01 (but include on KH07A and KH07AR). Count from DTA for this provider and deduct period of suspension from waiting time.
Patient offered admission  
Patient offered a date for admission but refuses this for personal reasons in advance of the date (self-deferred). Count from the admission date the patient refused.
Patient offered a reasonable date for admission but refuses this for personal reasons in advance of the date (self-deferred).

For a verbal admission date to be deemed reasonable, the patient is to be offered a minimum of two admission dates, with at least three weeks notice before the first of these admission dates.

For a written offer to be deemed reasonable, the patient is to be offered an admission date with a minimum of three weeks notice before the first of these admission dates.
Count from the first offered admission date the patient refused.
Patient offered a date for admission but does not turn up and gives no advance warning (as for self-deferred). Count from the admission date which the patient failed to attend.
Patient offered a date for admission but this is subsequently cancelled by the hospital. Count from DTA for this provider
Patient admitted but treatment deferred. Patient sent home and new DTA made. Count from new DTA for this provider.
Patient admitted and treatment completed. Remove from waiting list.
Patient removed from waiting list (emergency admission for same condition, death, other reasons). Remove from waiting list.


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