The AHP access waiting times applies to referrals, which are not on a consultant-led 18-week pathway, to AHP services. There is no national waiting time target attached to the AHP access waiting times period, although the KCHFT standard of 12 weeks is measured against where no contractual targets exist the professional groups include: -

• Podiatrists
• Dietitians
• Occupational Therapists
• Orthoptists
• Physiotherapists
• Radiographers
• Speech and Language Therapists
• Paediatricians.

KCHFT’s services not eligible under the 18-week RTT or AHP access waiting times will adhere to the principles within this policy, especially to those relating to cancelled or non- attended appointments.

Equality, Diversity and Inclusion

Communication and the provision of information are essential tools of good quality care. To ensure full involvement and understanding of the patient and their family in the options and decision-making process about their care and treatment, all forms of communication (e.g. sign language, visual aids, interpreting and translation, or other means) should be considered and made available if required. These principles should be enshrined in all formal documents.

Kent Community Health NHS Foundation Trust is committed to ensuring that information is provided in accessible formats and communication support is met for people (patients, carers, parents/guardians) with a disability, impairment or sensory loss. The Accessible Information Standard (AIS) is a legal requirement of the Equality Act which applies to all organisations included within the Health and Social Care Act. Guidance on professional support services for the trust is available in the Accessible information policy.

Equality analysis

Kent Community Health NHS Foundation Trust is committed to promoting and championing a culture of diversity, fairness and equality for all our staff, patients, service users and their families, as well as members of the public.

The Equality Analysis for this policy is available upon request by contacting the Engagement Team via kchft.equality@nhs.net.

Staff responsible for booking appointments of any type

All correspondence with patients has to explain how to change appointments and the impact of a cancellation or DNA (did not attend). Administrative processes have to accommodate patients’ ability to contact the appropriate location, to be able to change their appointments and agree a subsequent date.

Referrers

GPs should ensure patients understand their responsibilities when being referred and ensuring patients are referred under the appropriate clinical guidelines. All referrals should contain a robust clinical set of information, along with the relevant patient details. KCHFT may not accept the referral if this is missing.

Key principles of waiting list management

KCHFT has a duty to ensure all patients who are referred and accepted are offered the service within the waiting time standards.

The process of waiting list management should be transparent. Communication with patients should be informative, clear and concise.

• Patients will have access to this policy and should be aware of their responsibilities.
• Written operational procedures and protocols and appropriate user training support this policy.

Military veterans

In line with the Armed Forces Covenant, published in 2015, all veterans and war pensioners should receive priority access to NHS care for any conditions related to their service, subject to the clinical needs of all patients. Military veterans should not need first to have applied and become eligible for a war pension before receiving priority treatment.

• GPs will notify the trust of the patient’s condition and its relation to military service when they refer the patient, so the trust can ensure it meets the current guidance for priority service over other patients with the same level of clinical need. In line with clinical policy, patients with more urgent clinical needs will continue to receive priority.

Waiting times targets

It is expected that 92% of patients will commence treatment (local SOPs will define initiation of treatment) within 18 weeks for those services working against the 18-week RTT standard. Whilst there is no NHSE waiting time target attached to the non-consultant-led AHP access waiting times period the KCHFT standard is that patients should receive quality care without unnecessary delay. The aim of KCHFT is to see all AHP patients within 12 weeks of referral to the services.

For patients on a diagnostic pathway, the target is to complete diagnostic testing within 6 weeks in 99% of cases.

Patients who do not attend (DNA) application of rules

A DNA is defined as any scheduled appointment/procedure that is missed without prior notification by or on behalf of the patient.

Where patients frequently DNA and/or are re-referred by their GP for the same condition the service needs to discuss the issue with the patient’s GP to agree a way forward. Services must ensure they follow the KCHFT Safeguarding Policy/guidelines and any actions documented in the patient notes.

Children under age 16 years and vulnerable adults

KCHFT staff have a responsibility to use every opportunity to engage children, young people, adults and their families/carers to make positive health choices and to influence behaviour change.

Patients who are unavailable

Referrals should not be made for patients who are known not to be available for appointments or unfit for treatment within the next 18 weeks (RTT) or 12 weeks (access waiting times), for example, patients who will be out of the area for more than three weeks during the initial wait timescale or patients who have known underlying medical problems that require further investigation.

Patients will be allowed one change of appointment only during their initial treatment pathway. When patients request a further change of appointment, the patient must be informed that this change will result in their removal from the waiting list and discharge back to the referrer. If the patient still wishes to cancel, they will be referred back to their referrer and the episode discharged. This will nullify the clock and the RTT/Access waiting time pathway will be closed. Any subsequent re-referral will start a new clock.

The patient should be offered and agree to a further appointment within two weeks of the original appointment. Where a patient cannot agree a new appointment within this timeframe they will be discharged and referred back to their referrer. An exception would be if appointment choice was reduced due to lack of clinic availability.

Patients who do not rebook their first appointment at all within a three week period will have the referral returned to the referrer and the clock will be nullified.

All correspondence with the patient sets out how to change an appointment and the impact of a DNA or ‘was not brought’. Administrative processes must ensure that patients are able to contact the appropriate location to be able to change their appointments and agree a subsequent date.

KCHFT initiated change

If KCHFT changes an appointment a minimum of five working days’ notice must be given to the patient of the change. If five working days is not possible, the patient will be contacted at the earliest opportunity. The RTT/Access wait or diagnostic clock will continue during this time.

KCHFT will avoid changing patient’s appointments and in order to do so:

• Clinicians will ensure at least six weeks’ notice is given for annual and study leave.
• The trust will give wherever possible a six week notice period for meetings at which clinicians are required to attend.

Patient initiated discharge

If a patient no longer requires continuation of their care pathway and communicates this to KCHFT, this counts as a patient-initiated discharge which results in the episode of care being closed and the referrer informed. This closes the RTT/Access wait pathway and the service nullifies the clock.

Operational delivery and implementation

Referral letters are required to be acted on promptly. Patients will be allocated to the clinician/practitioner having the shortest waiting time and appropriate clinical skills to meet the patients’ needs based upon referral information.

Patient waiting over 52 weeks for commencement of treatment for the consultant-led RTT will have a harm review completed.

Inter provider transfer

Where a decision is made that a patient will be referred onto an acute trust the referral must be sent within two days of the decision being made.

For inter provider patient transfers (IPT) from an acute trust to KCHFT a similar form should be received.

Patients waiting over 52 weeks for a consultant-led referral

Should a patient be referred into a consultant-led service within the trust and their wait time for treatment exceed 52 weeks, the Performance team will contact the service lead to ensure that a harm review is completed for that patient. This form will be signed off by the Head of Service and Community Service Director, as well as being subject to a clinical review by the Chief Nurse. A copy of the completed harm review will be uploaded to the patient clinical record.

Directory of service

Further information on the services provided by KCHFT can be found on the trust website. The website provides a searchable format for all services A-Z.  To search via the internal website flo you can find services by following the links on the who’s who tab at the top of the homepage or by using the search bar at the top right of the homepage. You can find information on:

• Name of service
• Who they are
• What they do
• Where the service is provided
• Opening times
• How to contact the service
• Each page also gives a current rating of the service and comments left by service users.

Glossary and abbreviations

• KCHFT - Kent Community Health NHS Foundation Trust
• RTT - Referral to treatment
• RIO - Servelec RIO Electronic Patient Record System
• DNA - Did not attend
• HOS - Heads of Service
• DM01 - Diagnostic National Return
• WNB - Was Not Brought