C28-Week Non-Engagement Warning

Purpose

The final formal stage of non-engagement: one warning letter to the patient and their GP, giving 8 weeks to respond before the case returns for a discharge decision. One template is used for every reason - the reason is the only variable content.

Procedure

1. Confirm MDT approval. The warning may not be issued without prior discussion at the Daily Brief or Complex MDT. Where medication is involved, the decision to discontinue is taken at the same discussion.
2. Issue the 8-week warning letter to the patient, copied to the GP so the practice knows the patient has not responded. Populate the template with the specific reason.
3. Record the expiry date on the tab - date sent plus 8 weeks.
4. Where medication is involved: send the discontinuation notification confirming medication is stopped until the patient makes contact, and remove the patient from the titration sheet so the practitioner does not issue a further prescription.
5. During the 8 weeks, if the patient makes contact - filter out of the tab, resume the original pathway, reinstate medication where applicable.
6. At expiry with no contact, take the case to the Daily Brief. Every expired case is reviewed; none are auto-discharged. The Daily Brief decides: further appointment, further attempt, or discharge.
7. If discharged, route to C5.

Fields recorded

NHS number · name · reason for warning · date letter sent to patient · date sent to GP · expiry date · date of patient contact · Daily Brief date · outcome / next steps

Variations

Shared care - Where the patient has not had the required 6-monthly contact, the warning also confirms the GP has been notified and that prescribing responsibility transfers after 8 weeks. If the patient does not respond, medication is stopped - recorded as early shared care retained.

Notes

• Does not apply to new referrals who have never engaged. Those are discharged directly under C3.
• The letter is firmly worded but professional. One approved template, held centrally.
• The GP copy is not optional - it is what makes the practice aware the patient is disengaging.

Flowchart