NHS Information Authority

Data Standards Programme

Attribute ATTENDANCE DATE is a generic attribute used to record the date of an attendance for entity types:- AUDIOLOGY ATTENDANCE, CLINIC ATTENDANCE NON-CONSULTANT, GENITO-URINARY CLINIC ATTENDANCE, GMP CONSULTATION, OUT-PATIENT ATTENDANCE CONSULTANT and WARD ATTENDANCE.

It was also used to record the 'appointment date' for an OUT-PATIENT APPOINTMENT; this has proved confusing, especially when providing guidance for calculation of waiting times or completion of central returns.

A new generic attribute, APPOINTMENT DATE for recording the date of an appointment for OUT-PATIENT APPOINTMENT has therefore been introduced into the NHS Data Dictionary & Manual.

The definition of a CONSULTANT OUT-PATIENT EPISODE states 'A CONSULTANT OUT-PATIENT EPISODE starts on the date the PATIENT first sees the CONSULTANT at an OUT-PATIENT ATTENDANCE CONSULTANT.' however, the relationship from OUT-PATIENT APPOINTMENT CONSULTANT to CONSULTANT OUT-PATIENT EPISODE was mandatory. This was anomalous as the appointment preceded the attendance, but the episode did not exist until the attendance took place. The relationship has therefore been changed from mandatory to optional, so that an appointment can occur without an episode having to be created.

OUT-PATIENT APPOINTMENT

Attributes of this Class are:

K		APPOINTMENT DATE
K		APPOINTMENT TIME
K		ATTENDANCE DATE
		APPOINTMENT BOOKING SYSTEM TYPE
		ATTENDED OR DID NOT ATTEND

OUT-PATIENT APPOINTMENT CONSULTANT

Each OUT-PATIENT APPOINTMENT CONSULTANT

	must be related to one and only one CONSULTANT CLINIC SESSION
	must be related to one and only one CONSULTANT OUT-PATIENT EPISODE
	may be related to one or more APPOINTMENT SLOT
	may be related to one and only one CONSULTANT OUT-PATIENT EPISODE
	may be related to one or more OUT-PATIENT ATTENDANCE CONSULTANT

APPOINTMENT DATE

APPOINTMENT DATE

The date of an appointment. In the case of a PATIENT attending an OUT-PATIENT CLINIC without prior notice or appointment, the PATIENT will given an OUT-PATIENT APPOINTMENT.

This attribute is also known by these names:

Context	Alias
plural	APPOINTMENT DATES

ATTENDANCE DATE

The date of an attendance, or appointment to attend, for example at a CONSULTANT CLINIC, NURSE CLINIC, ACCIDENT AND EMERGENCY DEPARTMENT, or by a ward attender. The date of an attendance, for example at a CONSULTANT CLINIC, NURSE CLINIC, ACCIDENT AND EMERGENCY DEPARTMENT or by a ward attender.

This attribute is also known by these names:

Context	Alias
plural	ATTENDANCE DATES

APPOINTMENT DATE

APPOINTMENT DATE

Format/length:	n8 - ccyymmdd
HES item:
National Codes:
Default Codes:

This data element is also known by these names:

Context	Alias
plural	APPOINTMENT DATES

LAST DNA OR PATIENT CANCELLED DATE

Format/length:	n8 - ccyymmdd
HES item:
National Codes:
Default Codes:

Notes:
For Elective Admission List CMDSs, this date is derived from OFFERED FOR ADMISSION DATE and ADMISSION OFFER OUTCOME and is needed to meet central requirements. It is recorded when PATIENTS who have been offered a date for admission have missed this admission date with or without advance notice.

For Out-Patient Attendance CDS, the three dates, REFERRAL REQUEST RECEIVED DATE, ATTENDANCE DATE and LAST DNA OR PATIENT CANCELLED DATES, together provide all the information needed to derive the out-patient waiting time for the QM08 return. For Out-Patient Attendance CDS, the four dates, REFERRAL REQUEST RECEIVED DATE, APPOINTMENT DATE, ATTENDANCE DATE and LAST DNA OR PATIENT CANCELLED DATE, together provide all the information needed to derive the out-patient waiting time for the QM08 return. Both APPOINTMENT DATE and ATTENDANCE DATE may be required to calculate waiting times if the PATIENT cancels an appointment or did not attend and then subsequently attended at a future date.

This data element is also known by these names:

Context	Alias
plural	LAST DNA OR PATIENT CANCELLED DATES

OUT-PATIENT ATTENDANCE CDS TYPE

COMMISSIONING DATA SET (CDS)

OUT-PATIENT ATTENDANCE CDS TYPE

The Out-Patient Attendance Commissioning Data Set Type carries the data for an Out-Patient Attendance or a missed appointment. The data set only applies for Consultant attendances and appointments. The column headed Opt (Optionality) shows whether the Data item is Mandatory M, Optional O or Must Not Be Used *.
Opt	CDS Data Item	U/A
Person Group (Patient): To carry the personal details of the Patient. One occurrence of this Group is permitted.
M	LOCAL PATIENT IDENTIFIER
M	ORGANISATION CODE (LOCAL PATIENT IDENTIFIER)
M	ORGANISATION CODE TYPE
M	NHS NUMBERS
M	BIRTH DATES
O	CARER SUPPORT INDICATORS
*	ETHNIC CATEGORIES
*	MARITAL STATUS (psychiatric patients only)
M	NHS NUMBER STATUS INDICATOR
M	SEX
O	NAME FORMAT CODES
O	PATIENT NAMES
O	ADDRESS FORMAT CODE
O	PATIENT USUAL ADDRESS
M	POSTCODE OF USUAL ADDRESS
M	HA OF RESIDENCES
M	ORGANISATION CODE TYPE

Note: For reasons of confidentiality, the patient's preferred name and address (not including POSTCODE OF USUAL ADDRESS) must not be carried where a valid NHS Number is present.

(HCA) Consultant Out-Patient Episode - Person Group (Consultant): To carry the details of the responsible Consultant. One occurrence of this Group is permitted.
M	CONSULTANT CODES
M	SPECIALTY FUNCTION CODES
M	CONSULTANT SPECIALTY FUNCTION CODES
(HCA) Consultant Out-Patient Episode - Clinical Information Group (ICD): To carry the details of the ICD Diagnosis Scheme and the Diagnoses. Up to 2 occurrences of this Group are permitted.
O	DIAGNOSIS SCHEME IN USE
O	PRIMARY DIAGNOSIS (ICD)
O	SECONDARY DIAGNOSIS (ICD) (1st Secondary)
(HCA) Consultant Out-Patient Episode - Clinical Information Group (READ): To carry the details of the READ Diagnosis Scheme and the Diagnoses. Up to 2 occurrences of this Group are permitted.
O	DIAGNOSIS SCHEME IN USE
O	PRIMARY DIAGNOSIS (READ)
O	SECONDARY DIAGNOSIS (READ) (1st Secondary)
(HCA) Attendance Occurrence Activity Characteristics: To carry the details of the Out-Patient Attendance or missed appointment.
M	ATTENDANCE IDENTIFIERS
M	ADMINISTRATIVE CATEGORY
M	ATTENDED OR DID NOT ATTEND
M	FIRST ATTENDANCES
M	MEDICAL STAFF TYPE SEEING PATIENTS
M	OPERATION STATUS (per attendance)
M	OUTCOME OF ATTENDANCES
M	ATTENDANCE DATES
M	APPOINTMENT DATE
(HCA) Attendance Occurrence - Service Agreement Details: To carry the details of the Service Agreement for the Out-Patient Attendance.
M	COMMISSIONING SERIAL NUMBERS
O	NHS SERVICE AGREEMENT LINE NUMBERS
O	PROVIDER REFERENCE NUMBERS
M	COMMISSIONER REFERENCE NUMBERS
M	ORGANISATION CODES (CODE OF PROVIDER)
M	ORGANISATION CODE TYPE
M	ORGANISATION CODES (CODE OF COMMISSIONER)
M	ORGANISATION CODE TYPE
(HCA) Attendance Occurrence - Clinical Activity Group (OPCS): To carry the details of the OPCS coded Clinical Activities undertaken. Up to 12 occurrences of this Group are permitted.
O	PROCEDURE SCHEME IN USES
O	PRIMARY PROCEDURE (OPCS)
O	PROCEDURE (OPCS) (2nd to 12th, there may be up to 11 repetitions)
(HCA) Attendance Occurrence - Clinical Activity Group (READ): To carry the details of the READ coded Clinical Activities undertaken. Up to 12 occurrences of this Group are permitted.
O	PROCEDURE SCHEME IN USES
O	PRIMARY PROCEDURE (READ)
O	PROCEDURE (READ) (2nd to 12th, there may be up to 11 repetitions)
(HCA) Attendance Occurrence - Location Group - Out-Patient Attendance: To carry the details of the location for the Out-Patient Attendance - Site Code of Treatment. One occurrence of this Group is permitted. One occurrence of this Group is permitted.
M	LOCATION CLASS
M	SITE CODE (OF TREATMENT)
M	ORGANISATION CODE TYPE
(HCA) GP Registration: To carry the details of the Patient's Registered GMP. One occurrence of this Group is permitted.
M	GMP (CODE OF REGISTERED OR REFERRING GMP)
O	CODE OF GP PRACTICE (REGISTERED GMP)
O	ORGANISATION CODE TYPE
(HCA) Referral Activity Characteristics: To carry the details of the referral. One occurrence of this Group is permitted.
M	PRIORITY TYPES
M	SERVICE TYPE REQUESTEDS
M	SOURCE OF REFERRAL FOR OUT-PATIENTS
M	REFERRAL REQUEST RECEIVED DATES
(HCA) Referral Person Group: To carry the details of the referrer. One occurrence of this Group is permitted.
M	REFERRER CODES
M	REFERRING ORGANISATION CODES
M	ORGANISATION CODE TYPE
(HCA) Missed Appointment Occurrence: To carry the details of the missed appointment. One occurrence of this Group is permitted.
M	LAST DNA OR PATIENT CANCELLED DATES
(HCA) Healthcare Resource Group Activity - Activity Characteristics: To carry the details of the Healthcare Resource Group from 01/10/2001. Each CDS may contain only a single occurrence of this Group.
O	HEALTHCARE RESOURCE GROUP CODE
O	HEALTHCARE RESOURCE GROUP CODE-VERSION NUMBER

Note: If there is no HRG agreed for the Specialty, or samples only are required for the specialty which does not include this particular out-patient attendance, the segments relating to HRGs need not be sent. HRG Dominant Grouping Variable does not apply to out-patient attendances.

KH09 2

Central Return Form Guidance

KH09 - Consultant Outpatient Attendance Activity and Accident and Emergency Services Activity

Part 1: Consultant Outpatient Attendance Activity

Specialty

1. The consultant attendances should be counted by SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

2. Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODES, rather than the individual SPECIALTY FUNCTION CODESS of the CONSULTANTS concerned.

First Attendances - Seen

3. A count of all OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance and with an ATTENDANCE DATE within the quarter/year. The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the ATTENDANCE DATES.

First Attendances - DNA (Did Not Attend)

4. A count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the ATTENDANCE DATES of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is no OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.
     
     or
     
     where an OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE classification of First attendance is present for the PATIENT that the ATTENDANCE DATES of the OUT-PATIENT APPOINTMENT precedes that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the ATTENDANCE DATES of the OUT-PATIENT APPOINTMENT.

4. This is really counting appointments which would have resulted in First Attendances, had the patient not failed to attend. Hence it is a count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is no OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.
     
     or
     
     where an OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE classification of First attendance is present for the PATIENT that the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT precedes that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT.

Subsequent Attendances - Seen

5. A count of all OUT-PATIENT ATTENDANCES CONSULTANT with a FIRST ATTENDANCE classification of Follow-up attendance and with an ATTENDANCE DATES within the quarter/year. The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the ATTENDANCE DATES.

Subsequent Attendances - DNA (Did Not Attend)

6. A count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the ATTENDANCE DATES of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is an OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.

     and

   • the ATTENDANCE DATES of the OUT-PATIENT APPOINTMENT is after that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the ATTENDANCE DATES of the OUT-PATIENT APPOINTMENT.

6. A count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is an OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.

     and

   • the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT is after that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT.

KH09 3

Central Return Form Guidance

KH09 - Consultant Outpatient Attendance Activity and Accident and Emergency Services Activity

Part 1: Consultant Outpatient Attendance Activity - continued

Specialty

1. The consultant attendances should be counted by SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

2. Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANTS concerned.

First Attendances - Seen

3. A count of all OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance and with an ATTENDANCE DATE within the quarter/year. The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORIES which is current at the date of the ATTENDANCE DATE.

First Attendances - DNA (Did Not Attend)

4. A count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the ATTENDANCE DATE of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is no OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.
     
     or
     
     where an OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance is present for the PATIENT that the ATTENDANCE DATE of the OUT-PATIENT APPOINTMENT precedes that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORIES records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORIES which is current at the date of the ATTENDANCE DATE of the OUT-PATIENT APPOINTMENT.

4. This is really counting appointments which would have resulted in First Attendances, had the patient not failed to attend. Hence it is a count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is no OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.
     
     or
     
     where an OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance is present for the PATIENT that the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT precedes that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT.

Subsequent Attendances - Seen

5. A count of all OUT-PATIENT ATTENDANCES CONSULTANT with a FIRST ATTENDANCE classification of Follow-up attendance and with an ATTENDANCE DATE within the quarter/year. The count includes private patients. The ADMINISTRATIVE CATEGORIES records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORIES which is current at the date of the ATTENDANCE DATE.

5. A count of all OUT-PATIENT ATTENDANCES CONSULTANT with a FIRST ATTENDANCE classification of Follow-up attendance and with an ATTENDANCE DATE within the quarter/year. The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the ATTENDANCE DATE.

Subsequent Attendances - DNA (Did Not Attend)

6. A count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the ATTENDANCE DATE of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is an OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.

     and

   • the ATTENDANCE DATE of the OUT-PATIENT APPOINTMENT is after that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORIES records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORIES which is current at the date of the ATTENDANCE DATE of the OUT-PATIENT APPOINTMENT.

6. A count of all OUT-PATIENT APPOINTMENTS CONSULTANT where for the OUT-PATIENT APPOINTMENT:

   • the classification of ATTENDED OR DID NOT ATTEND is either Did Not Attend - no advance warning given or Patient arrived late and could not be seen

   and

   • the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT is within the quarter/year

     and

   • there is an OUT-PATIENT ATTENDANCE CONSULTANTS with a FIRST ATTENDANCE classification of First attendance present for the PATIENT.

     and

   • the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT is after that of the FIRST ATTENDANCE

   The count includes private patients. The ADMINISTRATIVE CATEGORY records whether a PATIENT is a private or NHS patient and should be the ADMINISTRATIVE CATEGORY which is current at the date of the APPOINTMENT DATE of the OUT-PATIENT APPOINTMENT.

Total

7. This is the total of all First Attendances (Seen and Did Not Attend) and Subsequent Attendances (Seen and Did Not Attend) for all SPECIALTY FUNCTION CODES.

   Total Private Patient Attendances

8. A count of all OUT-PATIENT ATTENDANCES CONSULTANT with an ATTENDANCE DATE within the quarter/year and where the classification of ADMINISTRATIVE CATEGORIES at the date of the ATTENDANCE DATE was Private patient.

Part 2: Accident and Emergency Services Activity

9. The second part of KH09 asks for a count of the total number of ACCIDENT AND EMERGENCY ATTENDANCES at A&E departments, divided into first attendances and follow-up attendances.

   A first attendance is the first within an A&E department for a given injury or condition and is identified by A+E ATTENDANCE CATEGORY with a classification of First ACCIDENT AND EMERGENCY ATTENDANCE - the first in a series, or the only attendance, in a particular ACCIDENT AND EMERGENCY EPISODE.

   A follow up attendance is identified by A+E ATTENDANCE CATEGORY classifications of Follow-up ACCIDENT AND EMERGENCY ATTENDANCE - planned: a subsequent planned attendance at the same department, and for the same incident as the first attendance and Follow-up ACCIDENT AND EMERGENCY ATTENDANCE - unplanned: a subsequent unplanned attendance at the same department, and for the same incident as the first attendance.

9. The second part of KH09 asks for a count of the total number of ACCIDENT AND EMERGENCY ATTENDANCES at A&E departments, divided into first attendances and follow-up attendances.
   
   A first attendance is the first within an A&E department for a given injury or condition and is identified by A+E ATTENDANCE CATEGORY with a classification of First ACCIDENT AND EMERGENCY ATTENDANCE - the first in a series, or the only attendance, in a particular ACCIDENT AND EMERGENCY EPISODE.
   
   A follow up attendance is identified by A+E ATTENDANCE CATEGORY classifications of Follow-up ACCIDENT AND EMERGENCY ATTENDANCE - planned: a subsequent planned attendance at the same department, and for the same incident as the first attendance and Follow-up ACCIDENT AND EMERGENCY ATTENDANCE - unplanned: a subsequent unplanned attendance at the same department, and for the same incident as the first attendance.

QM08 2

Central Return Form Guidance

QM08 - Out-Patient First Attendances Provider

Specialty Function (column 2)

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned. Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP Written (column 3) and Other (column 4).

GP Referral Requests (written)

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

Other referrals

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

• GP written referral requests;

• REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

• REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

• self referrals;

• referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;

• referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

All other sources of referral should be included, e.g:

• referral from an A & E Department;

• referral from a Consultant, other than in an A & E Department;

• referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

GP Written Referrals only (columns 5 to 10)

5. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

5. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks;
26 weeks and over.

6. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

8. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

1. The waiting time measures the interval between the last ATTENDANCE DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

9. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08 3

Central Return Form Guidance

QM08 - Out-Patient First Attendances: Provider - continued

Specialty Function (column 2)

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned. Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP Written (column 3) and Other (column 4).

GP Referral Requests (written)

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

Other referrals

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

• GP written referral requests;

• REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

• self referrals;

• referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;

• referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

All other sources of referral should be included, e.g:

• referral from an A & E Department;

• referral from a Consultant, other than in an A & E Department;

• referral from Prosthetist.

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

5. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks;
26 weeks and over.

6. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

8. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

9. The waiting time measures the interval between the last ATTENDANCE DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

9. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08 4

Central Return Form Guidance

QM08 - Out-Patient First Attendances: Provider - continued

Specialty Function (column 2)

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP Written (column 3) and Other (column 4).

GP Referral Requests (written)

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT. The REFERRAL REQUEST RECEIVED DATE of the GP REFERRAL REQUEST should be used to identify referrals to be included in the return.

Other referrals

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

• GP written referral requests;

• REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

• self referrals;

• referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;

• referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

All other sources of referral should be included, e.g:

• referral from an A & E Department;

• referral from a Consultant, other than in an A & E Department;

• referral from Prosthetist.

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

5. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks;
26 weeks and over.

6. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

8. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

9. The waiting time measures the interval between the last ATTENDANCE DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

9. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08R 2

Central Return Form Guidance

QM08R - Out-patient First Attendances: Responsible Population Based

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP written (column 3) and Other (column 4).

GP Referral Requests (written)

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

Other referrals

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

• GP written referral requests;

• REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

• self referrals;

• referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;

• referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

All other sources of referral should be included, e.g:

• referral from an A & E Department;

• referral from a Consultant, other than in an A & E Department;

• referral from Prosthetist.

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

5. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks;
26 weeks and over.

6. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

8. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

9. The waiting time measures the interval between the last ATTENDANCE DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

9. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08R 3

Central Return Form Guidance

QM08R - Out-patient First Attendances: Responsible Population Based - continued

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned. Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP written (column 3) and Other (column 4).

GP Referral Requests (written)

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

Other referrals

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

• GP written referral requests;

• REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

• self referrals;

• referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;

• referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

All other sources of referral should be included, e.g:

• referral from an A & E Department;

• referral from a Consultant, other than in an A & E Department;

• referral from Prosthetist.

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

5. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks;
26 weeks and over.

6. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

8. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

9. The waiting time measures the interval between the last ATTENDANCE DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

9. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QM08R 4

Central Return Form Guidance

QM08R - Out-patient First Attendances: Responsible Population Based - continued

1. All totals on the return are within SPECIALTY FUNCTION CODE. Note that SPECIALTY FUNCTION is based on SPECIALTY but is not identical to it.

Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned. Shared Care clinics should use the Joint Consultant Clinic Code (990) for SPECIALTY FUNCTION CODE, rather than the individual SPECIALTY FUNCTION CODES of the CONSULTANT concerned.

Number of referral requests for first Out-patient Appointments (columns 3 & 4)

2. This counts all REFERRAL REQUEST made in the quarter, which have the OUT-PATIENT REFERRAL INDICATOR set to Yes, split between GP written (column 3) and Other (column 4).

GP Referral Requests (written)

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

3. A count of written referrals from GENERAL PRACTITIONER, whether doctors or dentists, is required. These are GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to Yes. All written GP REFERRAL REQUEST to CONSULTANT should be recorded, regardless of whether they result in an OUT-PATIENT ATTENDANCE CONSULTANT.

Other referrals

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

• GP written referral requests;

• REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;

• self referrals;

• referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;

• referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

All other sources of referral should be included, e.g:

• referral from an A & E Department;

• referral from a Consultant, other than in an A & E Department;

• referral from Prosthetist.

4. This is a count of referrals other than GP written referral requests. It includes verbal referrals from GPs - GP REFERRAL REQUEST which have the WRITTEN REFERRAL REQUEST INDICATOR set to No. Do not include:

   • GP written referral requests;
   • REFERRAL REQUEST with SOURCE OF REFERRAL FOR OUT-PATIENTS recorded as Initiated by the Consultant responsible for the Consultant Out-Patient Episode;
   • self referrals;
   • referrals resulting in ward attendance for nursing care, which do not result in a CONSULTANT OUT-PATIENT EPISODE;
   • referrals resulting from attendance at a drop-in clinic. These are REFERRAL REQUEST where the OUT-PATIENT CLINIC REFERRING INDICATOR classification is Attended referring Out-Patient Clinic without prior appointment.

   All other sources of referral should be included, e.g:

   • referral from an A & E Department;
   • referral from a Consultant, other than in an A & E Department;
   • referral from Prosthetist.

GP Written Referrals only (columns 5 to 10)

5. Columns 5-8 of the return require the number of GP written referral first attendances seen during the quarter, broken down by the length of the wait. Waiting times are banded as:

less than four weeks;
four weeks and over but less than 13 weeks;
13 weeks and over but less than 26 weeks;
26 weeks and over.

6. Columns 9 and 10 require information on the number of GP written referral requests where the first out-patient attendance has not yet taken place at the end of the quarter, and where the PATIENT has been waiting 13 weeks and over but less than 26 weeks, and 26 weeks and over.

7. The waiting time is the interval between REFERRAL REQUEST RECEIVED DATE, the date the written referral request was received from the GP, or the date of the verbal request which was later confirmed, and the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT where FIRST ATTENDANCE is First attendance, the date when the patient sees the doctor for the first time for out-patient care.

   For those not yet seen, the waiting time is the interval from the REFERRAL REQUEST RECEIVED DATE and the day the quarter ends.

8. For patients who refuse an appointment or who fail to attend, whether giving advance notice or not, the waiting time is from the last missed appointment to the date when the patient is seen, or the date of the return.

   Note, however, that if an appointment is rearranged to an earlier date, or to another time on the same day, then it is not a missed appointment, and the waiting time should be calculated from the date the referral is received to the new scheduled attendance date.

9. The waiting time measures the interval between the last ATTENDANCE DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

9. The waiting time measures the interval between the last APPOINTMENT DATE of an OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient, and the ATTENDANCE DATE when the patient was seen. For those not yet seen, the waiting time is the interval between the last missed appointment and the day the quarter ends.

QMCW 1

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Contextual Overview

1. In terms of cancer waiting times, the Department of Health require information on waiting times for all PATIENT urgently referred by their GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER for suspected cancer by tumour site to monitor the following targets:

   	The "two week wait" from the date of decision to refer to the time the patient was seen by cancer specialist services, as described in the White Paper 'The New NHS'.
   	The maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia and the maximum one month wait from diagnosis to treatment for breast cancer. These targets are described in the NHS Cancer Plan, published in September 2000.

1. In terms of cancer waiting times, the Department of Health require information on waiting times for all PATIENTS urgently referred by their GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER for suspected cancer by tumour site to monitor the following targets:

   	The "two week wait" from the date of decision to refer to the time the patient was seen by cancer specialist services, as described in the White Paper 'The New NHS'.
   	The maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia and the maximum one month wait from diagnosis to treatment for breast cancer. These targets are described in the NHS Cancer Plan, published in September 2000.

2. The QMCW will monitor performance against these targets.

   NHS TRUST.

Completing Return QMCW - Cancer Waiting Times - Monitoring the Targets

3. QMCW is a quarterly return, the first quarter starting on 1 April and the last quarter ending on 31 March. Returns must be submitted by the twenty fifth working day after the end of the quarter. It comprises 4 parts:

   Part One:	Urgent referrals received within 24 hours
   Part Two:	Urgent referrals not received within 24 hours
   Part Three:	Guarantee of maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia
   Part Four:	Guarantee of maximum one month wait for all referrals from diagnosis to treatment for breast cancer

4. QMCW is completed by NHS TRUST.

5. The QMCW return requires the ORGANISATION CODE and ORGANISATION NAME of the NHS TRUST as well as the name of a contact, the contact's job title and the contact telephone number and fax number on the front page.

Parts One and Two

6. Comprehensive information on defining the two week standard can be found in the following Health Service Circulars:

   HSC 1998/242	Breast Cancer Waiting Times - Achieving the two week target
   HSC 1999/084	Collection of information on waiting times for suspected breast cancer patients in 1999/2000
   HSC 1999/205	Cancer Waiting Times. Achieving the two week target

7. PATIENT are included on the return where the OUT-PATIENT ATTENDANCE CONSULTANT is a FIRST ATTENDANCE and the ATTENDANCE DATE is during the period of the quarter covered by the return.

7. PATIENTS are included on the return where the OUT-PATIENT ATTENDANCE CONSULTANT is a FIRST ATTENDANCE and the ATTENDANCE DATE is during the period of the quarter covered by the return.

8. Parts One and Two comprise 13 main lines (Lines (a) - (m)) to report separately on PATIENT with different forms of suspected cancer. These are classifications of URGENT CANCER REFERRAL TYPE.

8. Parts One and Two comprise 13 main lines (Lines (a) - (m)) to report separately on PATIENTS with different forms of suspected cancer. These are classifications of URGENT CANCER REFERRAL TYPE.

Section a:	Breast Cancer
Section b:	Children's Cancers (these are PATIENT under 16 years of age)
Section b:	Children's Cancers (these are PATIENTS under 16 years of age)
Section c:	Lung cancer
Section d:	Haematological malignancies including leukaemia
Section e:	Upper Gastrointestinal Cancers
Section f:	Lower Gastrointestinal Cancers
Section g:	Skin Cancers
Section h:	Gynaecological Cancers
Section i:	Brain/Central Nervous system Tumours
Section j:	Urological Cancers
Section k:	Head and Neck Cancers
Section l:	Sarcomas
Section m:	Others

9. Totals for all cancers under these sections are included at the bottom of the form.

10. Referrals cover all GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE classification. These requests can be written or verbal, and can include those sent by electronic mail or using a telephone direct booking system.

11. The date the GP decides to refer a PATIENT is the URGENT CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

12. For monitoring purposes Parts One and Two requires information on referrals to distinguish between those referrals received within 24 hours of the URGENT CANCER REFERRAL DECISION DATE (by end of the next calendar day) and those which were not. The REFERRAL REQUEST RECEIVED DATE should be used by the NHS Trust to calculate this interval.

Part Three

13. Part Three monitors the waiting time in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer or suspected cases of relapse for Children's Cancers, Testicular Cancers and Acute Leukaemia to the date of the first definitive treatment if it is within the quarter.

14. Referrals cover all GP REFERRAL REQUEST with an URGENT CANCER REFERRAL DECISION DATE and an URGENT CANCER REFERRAL TYPE of b. Children's cancers, d.i. Acute leukaemia or j.i. Testicular cancers.

14. Referrals cover all GP REFERRAL REQUEST with an URGENT CANCER REFERRAL DECISION DATE and an URGENT CANCER REFERRAL TYPE of b. Children's cancers, d.i. Acute leukaemia or j.i. Testicular cancers.

15. The date the GP decides to refer a PATIENT is the URGENT CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

15. The date the GP decides to refer a PATIENT is the URGENT CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

16. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

16. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

Part Four

17. Part Four monitors the waiting time in calendar days from the date of the diagnosis to the date of the first definitive treatment for all PATIENT with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

17. Part Four monitors the waiting time in calendar days from the date of the diagnosis to the date of the first definitive treatment for all PATIENTS with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

18. The date of diagnosis is taken to be the date that the decision was made to treat the patient, which is the DECISION TO TREAT DATE.

19. As with Part Three, the date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

19. As with Part Three, the date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

Waiting Times for Parts One and Two

20. The waiting time is measured in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer or suspected cases of relapse to the OUT-PATIENT ATTENDANCE CONSULTANT of the OUT-PATIENT APPOINTMENT CONSULTANT made in respect of the urgent cancer referral, where FIRST ATTENDANCE is First attendance. Note that all out-patient referrals for suspected cancer where the first attendance is for endoscopy should be in Parts One and Two.

Patients who refuse an offer of an appointment

21. DSCN 23/2000 provided the following guidance on these Patient refusals:

    ‘Patient’s views should be considered when monitoring the two week rule and some patients might, for social or personal reasons, decline an appointment within 14 days. The waiting time of these patients who are offered an appointment but turn it down should be calculated from the date of the last appointment they were offered.’

    and

    ‘If a patient makes it clear that they do not want an appointment within 14 days before an offer is made, e.g. because they are going on holiday, the patient should be excluded from the QMCW return and monitoring of the ‘two week’ standard until the date when they become available for an appointment.’

    Both of the above are not currently supported by the NHS Data Dictionary & Manual and local arrangements for calculation of waiting times based upon the above guidance will be necessary until fully supported by the NHS Data Dictionary & Manual.

21. DSCN 23/2000 provided the following guidance on these Patient refusals:

    "Patient's views should be considered when monitoring the two week rule and some patients might, for social or personal reasons, decline an appointment within 14 days. The waiting time of these patients who are offered an appointment but turn it down should be calculated from the date of the last appointment they were offered."

    and

    "If a patient makes it clear that they do not want an appointment within 14 days before an offer is made, e.g. because they are going on holiday, the patient should be excluded from the QMCW return and monitoring of the 'two week' standard until the date when they become available for an appointment."

    Both of the above are not currently supported by the NHS Data Dictionary & Manual and local arrangements for calculation of waiting times based upon the above guidance will be necessary until fully supported by the NHS Data Dictionary & Manual.

Patients who do not attend their out-patient appointment

22. For PATIENT who fail to attend, whether giving advance notice or not, the waiting time is from the ATTENDANCE DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

22. For PATIENTS who fail to attend, whether giving advance notice or not, the waiting time is from APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

23. PATIENT who are referred back to their GP after failing to attend should only be counted again for Parts One and Two when they are re-referred for an urgent cancer referral. The waiting time should be calculated from the latest URGENT CANCER REFERRAL DECISION DATE of the re-referral.

23. PATIENTS who are referred back to their GP after failing to attend should only be counted again for Parts One and Two when they are re-referred for an urgent cancer referral. The waiting time should be calculated from the latest URGENT CANCER REFERRAL DECISION DATE of the re-referral.

Waiting times for Part Three

24. The waiting time is measured in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer or suspected cases of relapse to the date of definitive treatment (See Paragraph 15, above).

25. If the patient fails to attend or defers treatment, the waiting time will be adjusted. If the patient's treatment is cancelled or deferred by the health care provider the waiting time is not adjusted.

26. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

    	The time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT.
    	The time from the OUT-PATIENT ATTENDANCE CONSULTANT to the first offered START DATE of treatment.
    	The time from the first offered START DATE of treatment to the actual START DATE of treatment.

    If the patient is responsible for the delay in the START DATE of the treatment, the second of these time periods should be deducted from the waiting period. In this situation the waiting time therefore comprises the time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT, plus the time from the first offered START DATE of treatment to the actual START DATE of treatment.

26. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

    	The time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT.
    	The time from the OUT-PATIENT ATTENDANCE CONSULTANT to the first offered START DATE of treatment.
    	The time from the first offered START DATE of treatment to the actual START DATE of treatment.

    If the patient is responsible for the delay in the START DATE of the treatment, the second of these time periods should be deducted from the waiting period. In this situation the waiting time therefore comprises the time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT, plus the time from the first offered START DATE of treatment to the actual START DATE of treatment.

Waiting times for Part Four

27. The waiting time is measured in calendar days from the DECISION TO TREAT DATE to the date of definitive treatment (See Paragraph 15, above).

28. If the patient fails to attend or defers treatment, the waiting time will be adjusted. If the patient's treatment is cancelled or deferred by the health care provider the waiting time is not adjusted.

29. For admitted patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the date of the missed OFFER OF ADMISSION to the date when they actually were admitted, i.e. the START DATE of the HOSPITAL PROVIDER SPELL.

29. For admitted patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the date of the missed OFFER OF ADMISSION to the date when they actually were admitted, i.e. the START DATE of the HOSPITAL PROVIDER SPELL.

30. For out-patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the ATTENDANCE DATE of the last OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

30. For out-patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

QMCW 2

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Parts One and Two

1. Note: The same format is used for all 13 Lines of Parts One and Two. The detailed description of Line (a) Breast Cancer below applies to all subsequent lines for each specific URGENT CANCER REFERRAL TYPE, see PATIENT.

PATIENT

(a) Breast Cancer

2. Line (a) relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

2. Line (a) relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

Part one. Urgent referrals received within 24 hours

3. The first section counts all urgent cancer referrals received by NHS Trusts where the REFERRAL REQUEST RECEIVED DATE is within 24 hours of the URGENT CANCER REFERRAL DECISION DATE. Note; a referral will be considered to have been received within 24 hours if it is received by the next calendar day after the URGENT CANCER REFERRAL DECISION DATE.

3. The first section counts all urgent cancer referrals received by NHS Trusts where the REFERRAL REQUEST RECEIVED DATE is within 24 hours of the URGENT CANCER REFERRAL DECISION DATE. Note; a referral will be considered to have been received within 24 hours if it is received by the next calendar day after the URGENT CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist within 14 days of the decision to refer by their GP

4. This counts the number of PATIENT where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance was within 14 days of the URGENT CANCER REFERRAL DECISION DATE.

4. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance was within 14 days of the URGENT CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist after 14 days of the decision to refer by their GP

5. This counts the number of PATIENT where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance resulting from this referral was after 14 days of the URGENT CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

5. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance resulting from this referral was after 14 days of the URGENT CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

6. This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the the last OUT-PATIENT APPOINTMENT they failed to attend. PATIENT

   (Waiting Time Calculation)

   The calculation of the waiting time for these PATIENT is from the ATTENDANCE DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

6. This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the the last OUT-PATIENT APPOINTMENT they failed to attend. PATIENT

   (Waiting Time Calculation)

   The calculation of the waiting time for these PATIENTS is from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

Seen 15 to 16 days

7. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 15 to 16 days after the URGENT CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

7. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 15 to 16 days after the URGENT CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 17 to 21 days

8. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 17 to 21 days after the URGENT CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

8. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 17 to 21 days after the URGENT CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 22 to 28 days

9. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 22 to 28 days after the URGENT CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

9. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 22 to 28 days after the URGENT CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen after 28 days

10. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 29 days or more after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

10. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 29 days or more after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the the last OUT-PATIENT APPOINTMENT they failed to attend.

All Cancers Total

11. This is the total of all PATIENT counted in this part of the form, sub-divided by waiting time.

11. This is the total of all PATIENTS counted in this part of the form, sub-divided by waiting time.

Part two. Urgent referrals not received within 24 hours

12. The second section counts all urgent cancer referrals received by NHS Trusts where the REFERRAL REQUEST RECEIVED DATE is not within 24 hours of the URGENT CANCER REFERRAL DECISION DATE.

12. The second section counts all urgent cancer referrals received by NHS Trusts where the REFERRAL REQUEST RECEIVED DATE is not within 24 hours of the URGENT CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist within 14 days of the decision to refer by their GP

13. This counts the number of PATIENT where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance was within 14 days of the URGENT CANCER REFERRAL DECISION DATE.

13. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance was within 14 days of the URGENT CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist after 14 days of the decision to refer by their GP

14. This counts the number of PATIENT where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance resulting from this referral was after 14 days of the URGENT CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

14. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance resulting from this referral was after 14 days of the URGENT CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

15. This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the the last OUT-PATIENT APPOINTMENT they failed to attend.

    The calculation of the waiting time for these PATIENT is from the ATTENDANCE DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

15. This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the the last OUT-PATIENT APPOINTMENT they failed to attend.

    The calculation of the waiting time for these PATIENTS is from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

Seen 15 to 16 days

16. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 15 to 16 days after the URGENT CANCER REFERRAL DECISION DATE. see 6. for these PATIENT

    This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

16. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 15 to 16 days after the URGENT CANCER REFERRAL DECISION DATE. see 6. for these PATIENTS

    This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 17 to 21 days

17. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 17 to 21 days after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

17. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 17 to 21 days after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 22 to 28 days

18. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 22 to 28 days after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

18. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 22 to 28 days after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen after 28 days

19. This counts the number of PATIENT whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 29 days or more after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the the last OUT-PATIENT APPOINTMENT they failed to attend, see PATIENT for these PATIENT.

19. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 29 days or more after the URGENT CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the the last OUT-PATIENT APPOINTMENT they failed to attend.

All Cancers Total

20. This is the total of all PATIENT counted in this part of the form, sub-divided by waiting time.

20. This is the total of all PATIENTS counted in this part of the form, sub-divided by waiting time.

PATIENT

Lines (b) to (m)

21. Line (b) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected children's cancers.

21. Line (b) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected children's cancers.

22. Line (c) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected lung cancer.

22. Line (c) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected lung cancer.

23. Line (d) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected haematological malignancies including leukaemia.

23. Line (d) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected haematological malignancies including leukaemia.

24. Line (e) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected upper gastrointestinal cancers.

24. Line (e) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected upper gastrointestinal cancers.

25. Line (f) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected lower gastrointestinal cancers.

25. Line (f) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected lower gastrointestinal cancers.

26. Line (g) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected skin cancers.

26. Line (g) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected skin cancers.

27. Line (h) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected gynaecological cancers.

27. Line (h) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected gynaecological cancers.

28. Line (i) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected brain/central nervous system tumours.

28. Line (i) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected brain/central nervous system tumours.

29. Line (j) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected urological cancers.

29. Line (j) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected urological cancers.

30. Line (k) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected head and neck cancers.

30. Line (k) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected head and neck cancers.

31. Line (l) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected sarcomas.

31. Line (l) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected sarcomas.

32. Line (m) of Parts One and Two relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Other suspected cancer.

32. Line (m) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Other suspected cancer.

33. Each section is completed in the same way as Line (a).

QMCW 3

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Part Three - Guarantee of maximum one month wait from urgent GP referral to treatment

Note: The same format is used for the three sections. The detailed description of Children's Cancers, below applies to the two subsequent sections for Testicular Cancers and Acute Leukaemia.

Children's Cancer

1. This line relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of b Suspected children's cancers.

1. This line relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of b Suspected children's cancers.

Number of patients treated during the quarter within one month of the decision to refer by their GP

2. This counts the number of PATIENT where the number of days from the URGENT CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is 31 or less.

2. This counts the number of PATIENTS where the number of days from the URGENT CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is 31 or less.

3. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

3. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

4. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

   	The time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT.
   	The time from the OUT-PATIENT ATTENDANCE CONSULTANT to the first offered START DATE of treatment.
   	The time from the first offered START DATE of treatment to the actual START DATE of treatment.

   If the patient is responsible for the delay in the START DATE of the treatment, the second of these time periods should be deducted from the waiting period. In this situation the waiting time therefore comprises the time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT plus the time from the first offered START DATE of treatment to the actual START DATE of treatment.

4. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

   	The time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT.
   	The time from the OUT-PATIENT ATTENDANCE CONSULTANT to the first offered START DATE of treatment.
   	The time from the first offered START DATE of treatment to the actual START DATE of treatment.

   If the patient is responsible for the delay in the START DATE of the treatment, the second of these time periods should be deducted from the waiting period. In this situation the waiting time therefore comprises the time from the URGENT CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT plus the time from the first offered START DATE of treatment to the actual START DATE of treatment.

Number of patients treated during the quarter NOT treated within one month.

5. This counts the number of PATIENT where the number of days from the URGENT CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is more that 31. These counts are divided into those treated within 38, 48, 60 and more than 60 days.

5. This counts the number of PATIENTS where the number of days from the URGENT CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is more that 31. These counts are divided into those treated within 38, 48, 60 and more than 60 days.

But treated within 38 days of the decision to refer by their GP

6. This counts the number of PATIENT where the number of days from the URGENT CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is more that 31 but less than 39.

6. This counts the number of PATIENTS where the number of days from the URGENT CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is more that 31 but less than 39.

7. The next three sections,

   	'But treated between 39 and 48 days from the decision to refer by their GP'
   	'But treated between 49 and 60 days from the decision to refer by their GP'
   	'And not treated within 60 days of the decision to refer by their GP'

   
   

   are treated in the same way as described in Paragraph 6 above.

Testicular Cancers

8. This line relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of j.i Testicular cancer.

8. This line relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of j.i Testicular cancer.

Acute Leukaemia

9. This line relates to all PATIENT with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of d.i Acute Leukaemia.

9. This line relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of d.i Acute Leukaemia.

10. The lines on Testicular Cancers and Acute Leukaemia are completed in the same way as the lines on Children's Cancers.

QMCW 4

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Part Four - Guarantee of maximum one month wait from diagnosis to treatment for breast cancer

1. This section relates to all PATIENT with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

1. This section relates to all PATIENTS with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

Total number of patients treated during the quarter

2. This section is subdivided into the following.

GP urgent referrals

3. This counts the number of patients who are the subject of a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer and a CANCER REFERRAL PRIORITY TYPE of 2 - Urgent cancer referral identified by GP who have been treated in the quarter.

3. This counts the number of patients who are the subject of a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer and a CANCER REFERRAL PRIORITY TYPE of 2 - Urgent cancer referral identified by GP who have been treated in the quarter.

Other referrals

4. This counts all PATIENT with a PATIENT DIAGNOSIS of breast cancer other than those with a GP REFERRAL REQUEST where the CANCER REFERRAL PRIORITY TYPE of 2 - Urgent cancer referral identified by GP who have been treated in the quarter.

4. This counts all PATIENTS with a PATIENT DIAGNOSIS of breast cancer other than those with a GP REFERRAL REQUEST where the CANCER REFERRAL PRIORITY TYPE of 2 - Urgent cancer referral identified by GP who have been treated in the quarter.

Number of patients treated during the quarter within one month of the date of a clinical diagnosis being made by a responsible specialist

5. This counts the number of patients where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is 31 or less.

6. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

6. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

Waiting Time Calculations

7. For admitted patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the date of the missed OFFER OF ADMISSION to the date when they actually were admitted, i.e. the START DATE of the HOSPITAL PROVIDER SPELL.

8. For out-patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the ATTENDANCE DATE of the last OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

7. For admitted patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the date of the missed OFFER OF ADMISSION to the date when they actually were admitted, i.e. the START DATE of the HOSPITAL PROVIDER SPELL.

8. For out-patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

Number of patients treated during the quarter NOT treated within one month of the date of the clinical diagnosis being made by a responsible specialist.

8. This counts the number of PATIENT where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is more than 31. These counts are divided into those treated within 38, 48, 60 and more than 60 days.

But treated within 38 days of the date of that same clinical diagnosis

9. This counts the number of PATIENT where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is more than 31 but less than 39.

9. This counts the number of PATIENTS where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is more than 31 but less than 39.

10. The next three sections,

    	'But treated between 39 and 48 days from the date of that same clinical diagnosis'
    	'But treated between 49 and 60 days from the date of that same clinical diagnosis'
    	'And not treated within 60 days of the date of that same clinical diagnosis'

    are treated in the same way as described in Paragraph 10 above.

HP040 OUT-PATIENT ATTENDANCES

 HP040 Out-Patient Attendances 

KH09 CONSULTANT OUT-PATIENT ATTENDANCE ACTIVITY & ACCIDENT AND EMERGENCY SERVICES ACTIVITY

 KH09 Consultant Out-Patient Attendance Activity & Accident and Emergency Services Activity 

QM08 OUT-PATIENT FIRST ATTENDANCES - PROVIDER

 QM08 Out-Patient First Attendances - Provider 

QM08R OUT-PATIENT FIRST ATTENDANCES: RESPONSIBLE POPULATION BASED

 QM08R Out-Patient First Attendances: Responsible Population Based