Managing Waiting Times: A Good Practice Guide

MANAGING WAITING TIMES: A GOOD PRACTICE GUIDE

CHAPTER THREE
PRIMARY CARE

The Audit Scotland report, "Mind the Gap", covering management information for outpatient services stated, "clinicians need high quality timely information about patients referred in order to determine the appropriateness of the referral, the appropriate provision of services for each patient and the urgency with which they should be seen".

The Scottish Intercollegiate Guidelines Network (SIGN) report No. 31 "recommended referral document", identifies good practice regarding the content of referral documents. Primary Care should take account of the substance of this guideline when agreeing and managing the content of referral letters.

General Practitioners are central to the waiting time experience of their patients and should be provided with sufficient information to support their patients through their period of waiting, including the opportunity to influence the actual waiting time, the choice of clinic and arrangements for the clinic visit.

To support an effective partnership between Primary and Secondary Care on waiting time improvements, the following actions are recommended:

• It is often the case that general practice has more up-to-date and detailed information on a patient's circumstances than secondary care and hospitals should aim to link with general practice in the validation and updating of waiting lists.

• NHS Boards should take a lead in promoting the integration of waiting time information between general practice and secondary care. Where possible general practices should be provided with regular updates on outpatient and inpatient/day case waiting lists for their patients.

• Waiting List information may be complemented by the practice referral rates to the corresponding services. General practices will therefore be able to assess their referral rates in relation to waiting times, possibly in comparison with other practices.

General practices should consider having a written policy for patients who fail to attend for appointments, both at the practice and at secondary care. Such a policy should aim to support patients and minimise the level of failures to attend.

General practices may consider monitoring and if appropriate setting standards for the time between the decision to refer a patient to secondary care and the dispatch of the referral notification.

The planning process and local target setting to improve waiting times should have continuing and meaningful clinical involvement from both primary and secondary care. There should be clear clinical managerial leadership in ensuring that waiting time standards are delivered in a manner that does not distort clinical priorities and ensures that the patient's best interests are served.