Views:

Where a patient repeatedly fails to attend for planned care, or cancels at short notice, the following considerations should be applied:

  • Where a practice's contract agreement with the commissioning Primary Care Organisation (Integrated Care Board (ICB), Health Board in Wales) stipulates how many opportunities a patient should be given to fail to attend for treatment before a course of treatment claim is submitted as ?Incomplete Treatment?, these contractual obligations should be complied with. For example, the contract might state that a claim cannot be submitted as ?Incomplete Treatment? unless the patient has failed to return for completion of treatment on 2 consecutive occasions. NHS England and NHS Improvement's guidance is that the provider should have made at least one attempt to contact the patient (letter or phone) and not submit the COT for between 6-8 weeks to afford the patient a reasonable opportunity to complete treatment. After this period, should the patient have failed to contact the practice the claim could be submitted as incomplete.
  • The practice should have an agreed ?Fail to Attend?/?Short Notice Cancellation? Policy in place to ensure a consistent, fair and transparent process is undertaken when a patient fails to attend for an appointment or cancels at short notice. All members of the practice team should be familiar with, and comply with, the practice policy.

To ensure that incomplete courses of treatment claims are identified clearly, a Contract Performer should ensure that the following claim entries are made:

  • The date of the patient's last visit is recorded;
  • The appropriate ?Incomplete Treatment? charge band is entered on the claim to identify work that has been completed (Part 3 on form FP17). This is used to calculate the patient charge due;
  • The treatment band which reflects the treatment that has been started but not completed during that course of treatment is entered (Part 5 on form FP17). This is used to calculate the contract activity to be scheduled. The band crossed in Part 5 (FP17) must be the same as, or higher than, the band crossed in Part 3 (FP17).

Please note, the ?Late Submission? rule does not apply to claims submitted as ?Incomplete Treatment?.

The number of ?Incomplete Treatment? claims submitted is monitored. If unusual patterns of incomplete course of treatment activity are identified, these will be flagged up in an exception report to the Commissioner (ICB / Health Board).