Purpose

Holding the position of every patient on ADHD titration, so the service can answer the ICB at any point.

Procedure

1. Every patient on ADHD titration for medication is held on the master spreadsheet, on the tab for their funding stream: CAMHS, Right to Choose, Greater Manchester adult, or Private. Discharged patients stay on the sheet with their reason for discharge.
2. When the ICB asks how many patients the service holds, the answer is read directly off the sheet.
3. Where the ICB asks how many are non-engaging, filter on non-engagement.
4. At morning meeting, record the outcome of each patient's appointment and the plan arising from it in the annual review column - still in titration, did not attend, or moved to shared care. Where they have moved to shared care, enter next year's review due date.
5. Patients who have moved onto shared care are pulled from this sheet onto the contact sheet for their annual review (23).
6. Record the morning meeting date as the patient's Last updated date. Zak works the sheet A–Z weekly and pulls out anyone whose date has not moved in 6 weeks, to check whether they have fallen through the net and whether they need a reminder, a letter, or the Daily Brief.

Fields recorded

Per funding stream tab. Includes: patient identifiers · funding stream · engagement status · annual review outcome · shared care status · last updated

Notes

• The master spreadsheet and the contact spreadsheet are maintained separately and are not linked.
• Current state: the two sheets hold overlapping patient data with no reconciliation between them. Target state under Medicus: one patient record, with reporting as a view over it rather than a second hand-maintained sheet.

Open points

• Whether the columns are identical across all four funding tabs.
• What happens when a patient moves between funding streams, such as CAMHS to Greater Manchester adult at 18.

Flowchart

Open points

37 items still to confirm.

• C3 Contact Ladder & RAG Prioritisation - Full RAG criteria to be inserted. Referral source appears to be one factor - confirm the complete list.
• C5 Discharge - Whether anomaly discharges take a different ICB outcome code from standard discharges.
• C5 Discharge - Whether removal from active trackers is manually cross-checked, and by whom.
• 01 Referral Receipt & Triage - Full RAG criteria.
• 04 48-Hour Confirmation Calls - Whether a cancellation on this call automatically triggers the cancellation list, or admin picks it up separately.
• 05 Cancellation List - Whether ad-hoc follow-ups (06) take priority over cancellation-list patients when a slot opens.
• 06 Ad-Hoc Bookings & Follow-Ups - How admin is told a patient only attended part of an assessment - whether the clinician adds them directly or an outcome code triggers it.
• 07 DNA Management - Whether a DNA is billable to the ICB.
• 08 Questionnaires - How questionnaires are originally sent out.
• 09 ADHD Assessment Report - Whether the SLA metrics are a formal contractual return or internal tracking only.
• 11 Full Psychiatric Assessment Report - How consent is captured and where it is recorded.
• 12 Post-Diagnostic - Whether resources sent differ for patients not given a diagnosis.
• 13 Autism 6-Week Follow-Up - What happens if the offer letter expires with no response - whether the patient is chased or moves straight to the 12-week stage.
• 13 Autism 6-Week Follow-Up - Whether the follow-up must be with the diagnosing practitioner.
• 14 Report Amendments - Whether the time-to-action metric measures admin processing time or total turnaround including clinician review.
• 15 Titration & Episodes - Whether an episode that ends in DNA or non-engagement is still billable.
• 16 Observations - How patients submit their obs - digital form or read out during a booked call.
• 17 Blood Pressure Machines - What happens if tracking shows the machine was not delivered or is lost.
• 19 ECG & Investigation Chasing - What puts a patient onto the ECG tab in the first place.
• 19 ECG & Investigation Chasing - Who performs the ECG - in-house, GP or external provider.
• 19 ECG & Investigation Chasing - Who chases the report when the ECG is done but the report has not arrived.
• 20 Pregnancy Pathway - Which leaflets and information make up the pregnancy pack.
• 20 Pregnancy Pathway - Whether the pause stops waiting-list clocks for ICB reporting purposes.
• 21 Shared Care Agreement & GP Liaison - Whether an explicit or implied rejection triggers a funding review with the ICB.
• 22 Shared Care Prescribing & 6-Month Review - Whether gap-filling prescriptions carry a different billing code.
• 23 Annual Review - Whether the review due date is calculated from the referral date, the first appointment or the last review.
• 23 Annual Review - What happens to non-shared-care patients past a year.
• 24 Clinical Task List - Whether tasks carry due dates and named assignees.
• 24 Clinical Task List - Where the list currently lives.
• 25 Admin Task List - How chase frequency is set - standard interval or specified by the requester.
• 25 Admin Task List - Whether a formal template exists for instructing a GP to stop prescribing.
• 26 ICB Coding & Activity Recording - The full outcome code set. Codes 7 and 3 are confirmed; the codes for attended-with-diagnosis, attended-without-diagnosis and attended-needs-treatment are not yet written down.
• 26 ICB Coding & Activity Recording - Whether the ICB code set is documented anywhere that can be attached to this SOP.
• 26 ICB Coding & Activity Recording - How Care Act ID and Care Contact ID are generated.
• 27 Invoicing - Whether an episode ending in DNA or non-engagement is billable.
• 28 Master Spreadsheet & ICB Reporting - Whether the columns are identical across all four funding tabs.
• 28 Master Spreadsheet & ICB Reporting - What happens when a patient moves between funding streams, such as CAMHS to Greater Manchester adult at 18.