National 18 weeks team

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Reducing Elective Waits18 weeks and dental
pathways

• National 18 weeks team

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Context of the 18 week target

• 18 weeks - a commissioner target
• 18 weeks from GP referral to first treatment
• Applies to all patients referred to consultant
  led services, including dental services
• Measuring referral to treatment time RTT

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What are the benefits of 18 Weeks?
18 weeks

• For Patients
• Faster treatment and care
• Earlier diagnosis
• Earlier relief of symptoms
• Fewer hospital visits
• Reduced anxiety
• Greater confidence in the NHS

• For Staff
• Easier to plan and manage workload
• Better use of professional time
• More productive working
• Closer working between GPs and hospital
  clinicians
• Knowing where patient are on their pathway

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What is the 18 week pathway?
18 Weeks
GP
IP
OP
D
OP
Decision to treat
Treatment
GP Visit
1st OutpatientAppointment
The time from the first outpatient to decision to
treat includes many of the most significant
challenges including all diagnostics and
subsequent outpatients
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Referral to treatment waits
By March 2008
85 of admitted patients treated in 18 weeks 90
of non-admitted patients treated in 18 weeks


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The December target
The proposed standard of delivery for the NHS by
December 2008 is 90 for admitted patients and
95 for non-admitted patientsThis is being
tested with the NHS and will be confirmed in the
Operating Framework
Admitted patients 10
Non-admitted patients 5
Plus adjusted waits for patients wishing to wait
longer for their admission
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The national picture latest referral to
treatment performance
August data shows 76 non-admitted patients
started their treatment within 18 weeks
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The national picture specialty data
Proportion of admitted pathways with 18 weeks by
treatment function Aug 2007
within 18 weeks
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Clock Rules Starting the Clock (1)

• What starts the clock?
• Any referral from primary care to
• Consultant led service (irrespective of setting),
  including services delivered by SpRs as part of
  their training
• Cancer services
• Diagnostics that are straight to test
• Referral management centres (RMCs) and Integrated
  care, assessment and treatment services (ICATS)
• Practitioners with special interests if they are
  part of a referral-management arrangement

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Clock Rules Starting the Clock (2)

• What does not start the clock?
• Referrals to
• Non consultant led services
• Diagnostics that are not straight to test
• PRIMARY CARE dental services provided in a
  secondary care setting for undergraduate training
  purposes (dental schools) do not start a clock

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Clock Rules Starting the Clock (2)

• What does not start the clock?
• Referrals to
• Non consultant led services
• Diagnostics that are not straight to test
• PRIMARY CARE dental services provided in a
  secondary care setting for undergraduate training
  purposes (dental schools) do not start a clock

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Clock Rules Starting the Clock (3)

• What is the date of the clock start?
• The date when the provider receives notice of
  referral
• For Choose Book referrals, the date when the
  patient converts their UBRN
• If patient is referred to wrong specialty needs
  to be re-referred, the clock still starts on the
  date that the original referral letter was
  received or UBRN converted.

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Clock Rules Stopping the Clock (1)

• What stops the clock?
• First definitive treatment begins
• Decision not to treat
• Decision to embark on a period of watchful
  waiting or active monitoring
• Decision to return the patient to primary care
  for non consultant led treatment in primary care

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Clock Rules Stopping the Clock (2)

• What does not stop the clock?
• Administration of pain relief before a procedure
• Steps to manage condition before definitive
  treatment begins
• Consultant-to-consultant referrals where the
  underlying condition remains unchanged
• Making a tertiary referral or a referral from one
  provider to another

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18 week Commissioning Pathways

• The 18 week team have led the development of 35
  condition and symptom based (where possible) good
  practice commissioning pathways for the highest
  volume 12 specialties, including oral surgery.
• To
• Challenge existing practice
• Utilise service improvement tools and techniques
• Maximise opportunities for transformational
  change
• Support commissioners to deliver 18 weeks

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Principles

• Clinically driven
• Pathways must not be defined by whether they are
  delivered in primary or secondary care, or by
  which specialty or professional.
• Patient focussed
• Identify areas of clock stop and clock start
• Draw on the learning from a range of
  pilots/working groups
• Maximise opportunities for utilising service
  improvement to improve efficiency and
  productivity along the patient pathway
• Identify resource implications for adopting the
  pathway, including workforce and IT

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Dental pathways

• \Desktop\Updated_DentalPain_100907.pdf
• \Desktop\Updated_MouthLesion_100907.pdf

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Phase 2 - Examples (not all information is
necessarily applicable to this pathway)
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What can you do next?

• Address the key challenges
• Culture change clinically led across primary
  and secondary care
• Transforming pathways to deliver better services
  for patients
• Pathway measurement as opposed to numbers
• waiting
• Capture clock stops and clock starts
• Capture data electronically and link events
  this will support pathway management
• Processes for transferring data smoothly and
  efficiently between providers

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Thank you some useful resources

• 18 weeks resources, including commissioning
  pathways
• www.18weeks.nhs.uk
• Clock stop/start queries data18weeks_at_dh.gsi.gov.u
  k
• Primary Care Contracting
• www.primarycarecontracting.nhs.uk
• NHS Institute for Improvement and Innovation -
  tools and techniques, including the No Delays
  Commissioning Tool
• www.institute.nhs.uk