Whittington Health NHS
NHS / Health Body
Action Planned
The Trust will send a communication to all GPs via the GP Bulletin to remind them to include any information with regard to vulnerable patients or patients who lack capacity in the referral letter. They will also remind them of the option to request that out-patient appointment letters be copied to either a nominated patient representative for patients who lack capacity to attend appointments. (AI summary)
View full response
Dear Dr Brittain am writing to respond to your Prevention of Future Deaths report dated 8 June
2014. We regret and acknowledge Mr Pope's family's and your concern_ We have reviewed our processes, investigated what occurred in Mr Pope's case, and considered if any actions are required to prevent an occurrence of this nature in future. You raised the following concern: where a patient does not have capacity t make decisions about attending follow-up consultations, appointments might be missed when family members are not copied into correspondence. It was accepted that patient confidentiality would normally preclude such direct family involvement but that there may be circumstances When it is in the patients best interests to use this approach, to ensure follow Up occurs It was not clear the evidence heard at the inquest what steps are taken when a patient is deemed not to have Drocake mis Ivpe %i heaith Gecision; Concerns Were Faisedna oere hano Cackaipy process in place and that future deaths could occur as a consequence. summarise below; for completeness, our process for outpatient appointments and describe the safety net within this process for patients who lack capacity. On referra/ to the Trust for an out-patient appointment; the GPloriginal referrer must send completed-referral letter,which should include all appropriate information according to the Referral Minimum Dataset (MDS): As part of the MDS the referrer must include any other supporting information e.g: disability, mental health issues, child protection issues, which indicate that the patient may be vulnerable andlor require additional support: (Ref. Whittington Health Elective Access Policy, Section
10.1) [ucp UCLPartners Academic Health Sclencc Pertnershp Established as The Whittington Hospital NHS Trust Chairman: Mr Steve Hitchins Chief Executive: Mr Simon Pleydell from
referral is received, the patient is telephoned by a member of the Access When a appointment date and time.They are given theeopportuenitvuo Team to agree an They are reminded of their out- accept;, decline or to rearrange: the appointment. patent appointreno dater andtime via telephone 7 days before cteeirapieciieane the opportunity to accept; decline and rearrange, or decline the They are given to their appointment patients receive a reminder text appointment; TbhondavE byicelephoe,APpordo ot have theic ciobile number . on their mobile phones or by When patients do not attend (DNA) their out-patient appointment; theocliaiciarhe chaegepaftie1e patients care wii decide i a further appooitmeeng apiropriateatiere Trust Access Policy states that when patients do not attend their out-patient appointment they are discharged back to the care of their GP+ (Ref: Whittington Health Elective Access Policy, Section 11.3) A letter is sent to the patient and their to inform the GP of the patients non attendance ; which_was the case With HM GP when he missed his out-patient appointments_ If the GP is concerned that the Patent should be seen in their clinic, they can request a further appointment and the Booking Team in the Patient Access Centre will re-book the appointment: If a patient is deemed not to have capacity: and a formal letter or eMaiarenesccoss memberirepresentative or' clinician is made to the Patient Access tente aranieyt werbberaisecepcompting Ghe stati to copy appointment letters for that Centre , an alert representative. The Patient Access patient to family members, GP or the appointed which Bupervisor will place the alert on the Trusts Patient AdministratioenSystee s this request each time member of staff makes an appointment: The iigshoi regueameaahdiaddresteotpee Derson t0 whom the copies shouid bersenis Unfontonately iame Pope $ case, such an alert was not requested andchereforues out-patient appointment letters were not copied to anvone: Had such a request beepaeceived for Mr Pope, we would have been accommodated it; as described. To conclude, hope you are assured that the Trust has appropriate and robust processes in place with respect to patients who lack capacity to makeedecsionswe atceed sheir out-patient appointments: Having considered vour recommendationgwe aoenot feel that out processes or the Elective Access Policy require anv charges howeverwe do feel it wouid be helpful to send a communication to all the GPsiin our area reminding them of our safety net processes for patients who lack capacity to attend appointments: Action: The Trust will send a communication to all GPs Via the GP Bulletin to remind theck eformation with regard to vulnerable patients Or patients who lack to include any letter; and to remind them of the option to request that out- Daferi appoinireretertereteg Copieo rether oer @minated Qatient representative patient appointment for patients who lack capacity to attend appointments
2014. We regret and acknowledge Mr Pope's family's and your concern_ We have reviewed our processes, investigated what occurred in Mr Pope's case, and considered if any actions are required to prevent an occurrence of this nature in future. You raised the following concern: where a patient does not have capacity t make decisions about attending follow-up consultations, appointments might be missed when family members are not copied into correspondence. It was accepted that patient confidentiality would normally preclude such direct family involvement but that there may be circumstances When it is in the patients best interests to use this approach, to ensure follow Up occurs It was not clear the evidence heard at the inquest what steps are taken when a patient is deemed not to have Drocake mis Ivpe %i heaith Gecision; Concerns Were Faisedna oere hano Cackaipy process in place and that future deaths could occur as a consequence. summarise below; for completeness, our process for outpatient appointments and describe the safety net within this process for patients who lack capacity. On referra/ to the Trust for an out-patient appointment; the GPloriginal referrer must send completed-referral letter,which should include all appropriate information according to the Referral Minimum Dataset (MDS): As part of the MDS the referrer must include any other supporting information e.g: disability, mental health issues, child protection issues, which indicate that the patient may be vulnerable andlor require additional support: (Ref. Whittington Health Elective Access Policy, Section
10.1) [ucp UCLPartners Academic Health Sclencc Pertnershp Established as The Whittington Hospital NHS Trust Chairman: Mr Steve Hitchins Chief Executive: Mr Simon Pleydell from
referral is received, the patient is telephoned by a member of the Access When a appointment date and time.They are given theeopportuenitvuo Team to agree an They are reminded of their out- accept;, decline or to rearrange: the appointment. patent appointreno dater andtime via telephone 7 days before cteeirapieciieane the opportunity to accept; decline and rearrange, or decline the They are given to their appointment patients receive a reminder text appointment; TbhondavE byicelephoe,APpordo ot have theic ciobile number . on their mobile phones or by When patients do not attend (DNA) their out-patient appointment; theocliaiciarhe chaegepaftie1e patients care wii decide i a further appooitmeeng apiropriateatiere Trust Access Policy states that when patients do not attend their out-patient appointment they are discharged back to the care of their GP+ (Ref: Whittington Health Elective Access Policy, Section 11.3) A letter is sent to the patient and their to inform the GP of the patients non attendance ; which_was the case With HM GP when he missed his out-patient appointments_ If the GP is concerned that the Patent should be seen in their clinic, they can request a further appointment and the Booking Team in the Patient Access Centre will re-book the appointment: If a patient is deemed not to have capacity: and a formal letter or eMaiarenesccoss memberirepresentative or' clinician is made to the Patient Access tente aranieyt werbberaisecepcompting Ghe stati to copy appointment letters for that Centre , an alert representative. The Patient Access patient to family members, GP or the appointed which Bupervisor will place the alert on the Trusts Patient AdministratioenSystee s this request each time member of staff makes an appointment: The iigshoi regueameaahdiaddresteotpee Derson t0 whom the copies shouid bersenis Unfontonately iame Pope $ case, such an alert was not requested andchereforues out-patient appointment letters were not copied to anvone: Had such a request beepaeceived for Mr Pope, we would have been accommodated it; as described. To conclude, hope you are assured that the Trust has appropriate and robust processes in place with respect to patients who lack capacity to makeedecsionswe atceed sheir out-patient appointments: Having considered vour recommendationgwe aoenot feel that out processes or the Elective Access Policy require anv charges howeverwe do feel it wouid be helpful to send a communication to all the GPsiin our area reminding them of our safety net processes for patients who lack capacity to attend appointments: Action: The Trust will send a communication to all GPs Via the GP Bulletin to remind theck eformation with regard to vulnerable patients Or patients who lack to include any letter; and to remind them of the option to request that out- Daferi appoinireretertereteg Copieo rether oer @minated Qatient representative patient appointment for patients who lack capacity to attend appointments