HealthTech NHS Digital Outpatient Waiting List Platform — Foundation Trust

RTT Clock Management and Breach Prevention

NHS 18-week

RTT standard

patient referred by GP → first definitive treatment within 18 weeks (126 calendar days).

RTT clock start

first outpatient appointment following referral from NHS eRS.

Clock stop

first definitive treatment (first appointment, diagnosis, or surgical procedure).

Platform

per-patient RTT clock (days elapsed, current milestone, next action due), breach risk alert at 16 weeks (2 weeks remaining), automatic escalation to waiting list coordinator at 17 weeks, and breach notification to clinical governance at 18 weeks (1 day before breach).

NHS eRS Integration and Referral Triage

NHS e-

Referral Service FHIR R4

inbound referrals received via eRS appointment request (FHIR R4 ServiceRequest).

Triage

referral received → clinical triage (urgency categorisation — routine 18 weeks, urgent 2 weeks, 2-week wait cancer).

Appointment booking

outpatient appointment booked in NHS PAS (Patient Administration System) via FHIR R4 Appointment resource.

Appointment reminder

GOV.UK Notify 7 days before appointment (reduces DNA — Did Not Attend — rate by 40% on average).

Waiting List Validation and Active Monitoring

NHS England waiting list validation (monthly): all patients on waiting list validated as still requiring treatment and still waiting.

Validation workflow

• automated patient letter (GOV.UK Notify) → patient confirms still waiting (patient portal response) → records updated.
• Patients who do not respond within 14 days → GP notification → removal from waiting list if no response.

Clock review

RTT clock accuracy validated against PAS ADT events monthly.

Clinical safety hazard

patient removed from waiting list incorrectly (breach of duty of care).

Mitigation

removals require dual authorisation (clinical and administrative sign-off), removal reason code mandatory, audit trail immutable (every removal logged with user, reason, date, authorisation).

Second hazard

RTT breach not detected → patient waits beyond 18 weeks.

Mitigation

automated daily breach risk calculation, email alert to named waiting list manager for all patients within 3 weeks of potential breach.