Frequently Asked Questions

Reasonable offers of appointments and admissions

What is a reasonable offer?
A reasonable offer means that, subject to the exceptions of urgent appointments and infrequent services, patients should be offered up to two dates for outpatient, inpatient or day case services, regardless of method of communicating the offer - written, verbal or a combination of methods. Both of these dates should be at least three weeks in advance and within the national waiting times standard.

When possible, patients should be treated within their own Health Board area unless the service required is provided on a regional or national basis; (unless clinically inappropriate, patients will be considered as transferable within the clinical network in their health board area); if a treatment guarantee cannot be met locally and a patient may need to travel elsewhere, the patient must be made aware of this possibility as soon as it arises, preferably when the decision to refer or treat is made; appropriate transport arrangements (for patient and carer, if necessary) need to be resourced by the patient?s Health Board; the latter point regarding transport resourcing does not apply if the patient has requested to be treated elsewhere for personal reasons (e.g. relative living nearby).

It is important that patients are provided with clear, accurate and timely information about how processes will operate for arranging for them to be seen or to be admitted to hospital, and that they know how waiting times will be calculated. It is particularly important that where special rules apply (e.g. where it may be necessary for a hospital to offer treatment outside the health board area in order to meet the maximum waiting times guarantees, or where clinics are held infrequently by visiting clinicians) the implications of these are made clear to patients at the beginning of the process of arranging their clinic or admission, and explanations offered if requested.

We send patients a letter offering an appointment date and ask them to contact us if that date isn't suitable. Does this mean we now have to offer two dates in our letter?
No. If you offer the patient an appointment or admission date and they accept, this is considered a reasonable offer, but if the patient advises that the offered date is not suitable, they should be offered one other date. Dates offered should be at least 21 days in advance of the date the offers were made.

It is recommended that if offers are being made by writing, the letter should highlight the timescale in which the patient needs to make contact and also of the consequences if they do not make contact within that timescale.
Should the patient be referred back to their GP if they decline both dates offered?
Not necessarily. Where a patient declines both offers but there is a date that suits both parties, it is acceptable to offer that appointment/admission date.

We regularly have appointment slots at short notice (i.e. less than 21 days notice). Does New Ways mean that we should no longer offer these slots?
It is acceptable to offer short notice appointments or admission dates as long as you remember that if the patient declines the offer, it is not part of the reasonable offer rules and the patient should still be offered up to two further dates. If the patient accepts the short notice offer, this is then deemed to be  reasonable and no other offers are required.

Is it not unfair to ask these patients to make what may be long journeys, to attend a clinic when, if they wait a bit longer, they will be seen a lot nearer home?
We have a duty of care to ensure patients are given the first available appointment that is suitable to both parties. We should not therefore assume that patients are unable or unwilling to travel further to be seen earlier. Where patients decline these offers, they will still be able to be seen at their local clinic within the 'reasonable offer' criteria.

What should happen if a patient requests to be seen by a specific clinician even when there is no clinical requirement to do so?
While the patient has rights of choice, NHS Scotland has a responsibility to present the best possible options that are available to the patient to ensure that they are seen within waiting times guarantees. There are two options for dealing with these situations. One option is to make a reasonable offer of appointment, whether for the specified clinician or not and, if declined the guidance relating to declining an reasonable offer would apply. The second option would be to give a period of Social Unavailability from the date of the request until an appointment or admission with the specific Clinician becomes available.
[Updated on 20 April 2008 from 30 October 2007 original]

How much notice should we give patients before we can assume implied acceptance to a written offer?
New Ways is about the shared rights and responsibilities of hospitals and their patients so therefore there must be a realistic period of time given to allow the letter to be produced, sent, arrive at the patient's address, read and for any action to occur. Some Boards consider a fortnight to be a realistic time period for this to happen. [Added 20 April 2008]