Reflections on writing a model elective access policy


We spoke to our Director of Elective Care Improvement, Nigel Coomber about producing the model access policy and the themes that arose from our 4 May conference.

Hello and welcome to my second blog in which I’ll focus on two subjects: my reflections on writing a model elective access policy and the ‘expert help’ theme that arose from our 4 May conference, including how to access support from NHS Improvement and elsewhere, and best practice tools. 

I know we have received a significant number of requests to produce a model access policy over the last few years but I have personally been somewhat hesitant to write this, mainly because it’s hard for a central team to draft something that will cover all the many and varied elective care service models and ways of working in the NHS. 

Nigel Coomber our Director of Elective Care

What makes a good policy

A good access policy should be developed, agreed and implemented locally between trusts, commissioners, clinicians and patient representatives to reflect both national rules and specific local issues. My concern was that health systems could feel constrained by a national ‘template’ policy, and not as inclined to comprehensively develop their own version. That said, I realise there are some key areas of referral to treatment (RTT) rules where a particular form of words would be helpful and I see that advice regarding the structure and format of the policy can also be beneficial. 

My apologies

Please accept my apologies for the considerable time it has taken to develop the model access policy. The reality is it’s been hard to strike a balance between something detailed and definitive enough to help with the wording of local policies that also provides context and advice on the issues to be considered and agreed on at health community level.   

How to use the model access policy

We want the document to be used as guidance for providers and wider health systems. Please don’t copy and paste it − it contains elements that must be reviewed and amended to reflect local arrangements. Providers, wider health system leads and other key stakeholders should read the whole model policy to ensure they understand its principles and know where they need to adapt it for their local context.

The key point we’ve tried to get across in the policy is that such documents should be patient-focused; aiming to promote timely access to elective care, while also fully respecting patient choice about time and place of treatment. We have taken every care to avoid contradiction with national referral RTT rules, as these still take precedence, but if you do spot anything you believe to be erroneous or inconsistent with the rules and other national guidance, please do let us know. 

Indeed, all comments and feedback, positive and negative, are very welcome through:

Finally, you will note that the model access policy refers to the trust needing to have various standing operating procedures (SOPs) to underpin the access policy principles. Watch this space for model SOPs and guidance on writing them. 

Expert help

We received questions at our conference about:

  • how to access support and guidance in RTT training, demand and capacity and data quality
  • how to change the cultural landscape, with a particular focus on improving clinical ownership
  • how NHS Elect fits with NHS Improvement

I will cover training later, so first:

  1. Demand and capacity planning is one of the essential elements contributing to delivery of elective care standards. There is a national programme dedicated to this work, including the provision of training. 
  2. RTT data quality has been a theme of our work since the introduction of the RTT standard in 2008. We plan to publish guidance on improving data quality which covers areas such as data validation versus data audit, patient administration system (PAS) upgrade advice and training advice and guidance. Site-specific detailed data quality reviews can be agreed through regional teams – please email us for more information.
  3. Colleagues in the ACT Academy, also part of NHS Improvement, can support organisations and systems in assessing their culture for innovation and transformation and providing support and advice for improvement through a range of programmes. For more information, contact Julia Taylor, Director of the ACT Academy.
  4. NHSElect is a separate organisation to NHS Improvement that offers support on a membership subscription basis.


Training, and more specifically contextual elective care training is, I believe, akin to demand and capacity in being fundamental to getting patients treated as quickly as possible and so meeting national standards. But where to start? And what is contextual elective care training?

Contextual training is different from technical training. Most trusts have well evolved IT training functions that focus on PAS and other technical issues but typically do not go anywhere near the required depth in providing context and meaning to tasks staff are expected to carry out. Trusts therefore need to develop an elective care training strategy, setting out how these elements will be delivered.

There is no ‘one model fits all’ approach but it can work well to have a centrally managed team of elective care experts to co-ordinate and perhaps deliver this training. I say ‘perhaps’ because due to the large number of staff that will need a solid grounding in RTT and elective care pathways, e-learning could well be the most cost-effective and efficient way of providing the necessary training programme. There are elective care e-learning tools available, including our own recently launched e-learning programme but trusts should still consider how they might support staff who require more intensive one-to-one support, as well as clinicians who might prefer a face-to-face session with colleagues focusing on their own specialty. 

We have an array of training and expertise resources which will soon be posted on to our improvement hub. In the meantime, if you would like to discuss this in more detail, contact Lynn Neat, Improvement Manager.

A few final points

I would like to invite you to use our new discussion forum in our improvement hub to raise any queries or scenarios you would like advice on. Registration is required before posting but only takes a few minutes.

I hope you have found this useful and informative, and please look out for future blogs – I aim to produce these every 6 weeks or so.  

Please do follow me on Twitter: @nigel_coomber

Related content

Is there anything wrong with this page?

Help us improve this website

Do not include any personal, sensitive or confidential information.