1.1 This procedure is to ensure adequate arrangements exist for managing the creation, cancellation and amendment of clinics within an outpatient setting and so ensure that NHS Fife has control over capacity to meet demand in these areas. This will include the addition and reduction of the number of patients on any given clinic.
1.2 Lost capacity due to cancelled or reduced clinics has negative consequences for both the patient and the service provider’s ability to manage the appointment process and meet capacity in line with demand. Clinic cancellations and re-booking of appointments are an extremely inefficient way to use valuable resources.
1.3 This procedure, in combination with the Clinical Annual Leave policy, will minimise the disruption to clinical activity as a result of short notice changes due to planned leave. It is accepted that short notice cancellations may occur due to illness or other unplanned events. However the level of these cancellations will be monitored by the Service Managers, and action taken to reduce the risk to clinical activity.
1.4 It is essential that this is an agreed procedure, with clear clinical and managerial commitment to ensure it is followed.
2.1 Outpatient Departments within NHS Fife.
3.1 Clinical Director, Divisional General Manager, Service Manager and Health Records staff.
4.0 OPERATIONAL SYSTEM
4.1 All requests relating to the management of templates for all outpatient clinics must be submitted directly on the appropriate forms (see appendices) electronically or on paper to the Service Manager for approval/agreement. This agreement is required due to the impact to meet demand/capacity and NHS Fife’s ability to meet waiting times guarantees as well as in line with Clinician Job Planning.
4.2 On agreement by the Service Manager the appropriate forms will be forwarded electronically or on paper to Health Records. This must be done timeously to allow Health Records to process and ensure patients are processed.
4.3 Consultants should be made aware by Service Managers that verbal requests will not be processed by Health Records staff. Incomplete forms will not be processed by Service Managers or Health Records and will be returned to the originator. Only on full completion of the appropriate form (see appendices) will this be processed by Service Managers and Health Records staff. It is preferable that forms are submitted by email but will also be accepted in paper format.
4.4 If a clinician makes a direct request to Health Records for a clinic change/addition/reduction and the appropriate forms are not completed then this would be refused. If the clinician advises that the clinic alteration is to stand then this must be escalated immediately by Health Records staff to the Service Manager and/or General Manager for that area for resolution.
4.5 In the very exceptional circumstances where requests are made with less than 6 weeks’ notice, it will be the clinical teams responsibility, along with the General Manager to identify further capacity to accommodate any patients within a timeframe that is both clinically appropriate and within the national waiting times targets.
4.6 New/Revised/Additional Clinic templates
If a clinician wishes to establish a new clinic or permanently revise the booking template for an existing clinic, the clinic amendment form (Appendix 1) should be completed. Clinicians should agree changes with the Service Manager for their specialty, who will then sign off the changes and submit the form to the appropriate Health Records Manager (responsible for Outpatients) six weeks’ prior to any change being required. The date received by Health Records will define the start of the six weeks’ notice period.
No new clinics will be established or existing templates revised without completion of the clinic amendment form.
No new clinics will be established or existing templates revised with less than 6 weeks’ notice without exceptional circumstance.
Health Records will undertake to notify patients affected by clinic amendments at least ten working days prior to their original appointment.
4.7 Cancellation of Clinics
Clinicians are required to give six weeks’ notice of clinic cancellation.
Clinicians should agree changes with the Service Manager for their specialty, who will then sign off the changes and submit the form to the appropriate Health Records Manager (responsible for Outpatients) six weeks’ prior to any change being required. The date received by Health Records will define the start of the six weeks’ notice period.
In unforeseen circumstances where clinic cancellation is required with less than six weeks’ notice, clinicians should discuss the circumstances with the Service Manager responsible for that service. These may include court appearance, clinical service crises, sickness or bereavement. If no alternative arrangements can be made and the responsible Clinical Director and Divisional Management Team agree to the cancellation, Part 2 of the clinic cancellation form (Appendix 2, Part 2) should be completed by the clinician and signed off by the Clinical Director and General Manager prior to forwarding to Health Records as early as possible.
No clinics will be cancelled without completion of the clinic cancellation form.
Health Records will only be able to action requests for cancellations with a minimum of 6 weeks’ notice or if less than 6 weeks’ notice, accompanied by a completed form signed by the clinician, responsible Clinical Director and General Manager.
Health Records will undertake to notify patients affected by clinic cancellations at least 10 working days prior to their original appointment.
4.8 Reinstatement of cancelled clinics
If a clinician would like reinstatement of a previously cancelled clinic,
a request form (see Appendix 3) should be made to the Service Manager for their specialty, who will then sign off the changes and submit the form to the appropriate Health Records Manager (responsible for Outpatients) with a minimum of 3 weeks’ notice provided. The date received by Health Records will define the start of the 3 week period.
If 3 weeks or more notice is provided, then the clinic will be reinstated by the Health Records Manager who will be responsible for contacting Patients and for informing the responsible clinician that the clinic has been successfully reinstated.
Reinstatements with less than 3 weeks’ notice will not be considered by the Health Records department unless in exceptional circumstances and agreed with the General Manager.
4.9 Performance monitoring and feedback
A monthly report from Information Services regarding cancellations and short notice changes will be made available to Service Managers who will have responsibility for engagement and resolution of these issues with clinicians.
A summary report will be available to the General Managers and Director of Acute Services.
All emails relating to outpatient clinic management must be copied to Senior Charge Nurses for Outpatients.
Clinicians are responsible for managing their clinics but in doing so must ensure full adherence to current policy, procedures and nationally driven waiting times targets. The Service Manager is responsible for the performance and compliance of their specialities and should take all necessary steps to ensure targets are delivered.
In the event of the non availability of the Service Manager then this responsibility will move to a designated deputy.
5.0 RISK MANAGEMENT
5.1 It is the responsibility of Clinical Directors, Divisional General managers and Service Managers to ensure this Procedure is deployed within their area of responsibility.
6.0 RELATED DOCUMENTS
6.1 Appendix 1Outpatient Clinic Amendment Form
6.2 Appendix 2 Clinic Cancellation Form
6.3 Appendix 3 Clinic Reinstatement Form