The clinical prioritisation programme is a technical and clinical review of patients waiting for elective care treatment. The review originally focused on patients with a decision to treat and is now extending to include patients awaiting a diagnostic procedure.

The aim is to:

• assess clinical risk and prioritise patients on surgical and diagnostic waiting lists
• categorise patients in order of clinical urgency by checking their condition and risk factors (taking into account any comorbidities and potential health inequalities, ie ethnicity and depravation), and mapping to the appropriate P/D code to ensure a consistent approach across the clinical prioritisation programme
• introduce the P6 category, to record patients who choose to postpone their surgical treatment
• establish whether patients still wish to proceed with their procedure
• ensure good communication between the responsible clinician, the referring clinician and the patient, family or carer.

Clinical prioritisation is required because patients are waiting longer for elective care as a result of COVID-19. Where activity has been restricted, it has been necessary to ensure that patients are prioritised to effectively manage clinical risk and improve outcomes.

It is also important to update patients on their options, ascertain their current status and agree next steps.

In addition, the review will ensure that patients are not included on the waiting list where they do not meet the criteria in the Evidence-Based Interventions (EBI) guidance, and instead are provided with an alternative treatment for their condition.

The clinical prioritisation programme will enable providers to understand the level of clinical risk on their waiting lists, prioritise treatments and examinations for the most clinically urgent, and inform discussions with patients over their next steps. We recognise that risk is dynamic and can change depending on the individual circumstances.

Discussions with patients can support ongoing management and help inform decisions regarding their diagnostic and treatment options, depending on the patient’s best interests and clinical needs as whole – including mental health, comorbidities and potential health inequities. For more information, please see our guidance on good communications with patients waiting for care and the shared decision-making tool outlined in Appendix A of the clinical validation of surgical waiting lists framework.

The diagram in Appendix F of the clinical validation of surgical waiting lists framework shows the potential impact of each stage in the process.

Please refer to the National Waiting List Minimum Data Set requirements for this programme – see Q.10 for further information.

To support ongoing waiting list management, providers should be able to see the patient’s clinical priority alongside other waiting list information (including wait time).

SDM is an essential process whereby patients and clinicians work together to make evidence-based decisions centred on patient values and preferences. The example provided here has been adapted for the clinical validation of surgical waiting lists.

SDM principles should underpin any conversation with a patient. The SDM tool (available in Clinical validation of surgical waiting lists: framework and support tools) may be used by clinicians when planning patient care and delivery.

No; the clinician may decide to prioritise without further discussion or consultation, but only if there is enough information to clinically prioritise, and feedback from the patient supports this approach. This decision should take into account any other ongoing medical investigations or interventions or any potential barriers or considerations regarding ethnicity, language barriers, multi-morbidity or other factors relating to health inequalities.

Yes; patient involvement and shared decision-making is at the heart of this programme. The involvement of the patient is good practice throughout the NHS.   The outcome of any conversation or decision should be communicated to the patient and their GP and/or referrer in writing, ensuring that patients are provided with an appropriate point of contact for any queries.

Yes, e-Review has been developed specifically to facilitate the clinical review programme where appropriate.

No, e-Review is available to providers if there is no alternative solution that can capture the level of data required. Providers will still need to be able to record clinical prioritisation outcomes on a system in order to make the required submissions as part of the National Waiting List Minimum Data Set (MDS).

All providers are required to submit a standard weekly dataset to the national programme.  The National Waiting List Dataset specification is included as a contractual requirement for reporting purposes and has been shared with all providers.  The specification sets out all requirements for reporting on waiting list activity, with data being uploaded on a weekly basis into the new national data dashboard which providers can access to view their reported activity status.

It is at the provider’s discretion to prioritise cohorts of patients. However, we would suggest that cohorts are organised according to clinical need – taking into account the impact of health inequalities and multi-morbidity – and then in chronological order from the longest waiting patient. Providers should ensure that all cohorts of patients are considered, including surveillance patients.

A patient not responding to the validation letter does not warrant removing them from the waiting list. The provider should seek alternative avenues, eg calling the patient to check their status, or, as a final resort, contacting the GP. Trusts and local primary care communities should work together to determine how best to do this.

There is no change to the way that the patient’s fitness to proceed should be managed. Providers should refer to their access policy and national rules for management of these patients.

Patients in this cohort should be clinically reviewed and options for ongoing care discussed and agreed with the patient using shared decision-making principles. The outcome of this decision will inform the clock status in line with the provider’s local access policy and national rules.

The programme guidance asks that the referring GP receives communication on the clinical condition and confirmed next steps following review.

Yes, due to the initial and ongoing impact of COVID-19 on elective care it will be necessary to continue prioritising the waiting list to understand the composition and prioritise patients based on clinical urgency, taking into account the impact of health inequalities and multi-morbidity.

It will be standard operational process for providers to regularly undertake a review of the patients on the waiting list. As a basic principle, providers should aim to review patients once their time category has expired, i.e. a category 2 patient should be reviewed if they have not been treated after a month.