NHSScotland: national access policy

4. Key Principles

Patient Needs

• The needs of the patient should be paramount.
• Patients should be offered care according to clinical priority, with the most urgent being seen most swiftly.
• There should be collaborative working with stakeholders in primary, secondary and social care to ensure the needs of the patient are met.

Operational

• Health Boards should work collaboratively to match capacity with demand as much as possible, ensuring patients are seen as quickly as possible.
• As far as possible, patients should be seen within agreed waiting time standards, and those with the longest wait should be prioritised, along with those who are most clinically urgent.
• All urgent cancer patients are required to be seen as soon as possible within the cancer waiting time standards.
• Referrals should be managed effectively through Active Clinical Referral Triage.
• Patients should be referred to a clinical team and be seen by an appropriate member of that team rather than being referred to a named consultant. The Local Access Policy for each Health Board should set out that a reasonable offer of treatment relates to any competent clinician who is part of the consultant‑led service which the Health Board provides in that speciality or subspecialty.
• Sufficient capacity should be optimally utilised to deliver waiting times.
• There are only two reasons why a patient may be unavailable for treatment: medical reasons or patient-advised reasons. Patient-advised unavailability can only be applied at the request of the patient and must not be prompted by the Health Board. Unavailability reasons should be set out in each Health Board’s Local Access Policy.
• Patients should not be added to a waiting list until they are ready for treatment.
• Waiting list validation should be embedded in Health Board processes. In addition to local three-stage validation, the National Elective Coordination Unit (NECU) is available to support Health Boards with national waiting list validation. Further details of the work NECU do can be found online: National Waiting List Validation - How it works | The nation (nhscfsd.co.uk)
• The provision of day case and short‑stay surgery should be maximised.
• Admissions to hospital should be actively managed through pre‑assessment services.
• Effective patient booking systems should be in place to maximise capacity.
• All patients must be advised of any delay to their appointment as soon as possible. If there is a delay caused by the service, which is longer than the patient could reasonably be expected to wait, this would be classed as ‘Cancelled by Service’. A reasonable wait would be anything up to 30 minutes.

Accessibility

• Whilst the vast majority of patients are seen within their local area, services may also be delivered through another Health Board, National Treatment Centre or suitable alternative provider. The Local Access Policy for each Health Board should set out the locations and suitable alternative providers where treatment may be reasonably undertaken.
• Patients are to be advised as early as possible if they need to travel for their appointment or treatment.
• Patients should be advised that they may be entitled to have their travel costs, accommodation, and any other relevant expenses, for the patient and their carer (if necessary), covered by the Health Board. This should be set out in each Health Board’s Local Access Policy.
• Health Boards should consider whether it may be appropriate to provide transport to support a patient to attend an appointment.
• Health Boards should aim to achieve inclusive and equal access for all service users.
• A reasonable offer for first outpatient assessment and inpatient / day case admission is when:
• at least 10 calendar days notice is given;
• the appointment is at any location across NHSScotland;
• the mode of contact used for an appointment can be accepted by the patient (e.g. video, phone call);
• can be offered regardless of whether it is pre or post guarantee date; and,
• short notice offer is acceptable (if accepted by patient).
• The details of what constitutes a reasonable offer, along with the consequences of a patient refusing two reasonable offers of appointment, should be set out in the Health Board’s Local Access Policy.

Improvement

• Health Boards should work to understand the reasons why patients do not attend their appointments, and what support can be provided by Health Boards to reduce non‑attendance of agreed appointments. The consequences for patients of non-attendance should be set out in each Health Board’s Local Access Policy.
• Reduce follow-up appointments that are not clinically necessary.
• Feedback should be used to facilitate improvements in service provision.
• Leadership and accountability for the improvement of waiting times and achieving waiting times standards should be explicit within each Health Board area.