Coronavirus (COVID-19): supporting elective care - clinical prioritisation framework

The framework provides NHS Scotland with clear guidance for prioritising elective care whilst ensuring appropriate COVID-19 safety and priority measures are in place.

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This Framework for Clinical Prioritisation, which has been approved by the Chief Medical Officer and the Cabinet Secretary for Health and Social Care, has been adopted across NHS Scotland since November 2020.  The framework provides NHS Scotland with clear principles for prioritising Elective Care whilst ensuring appropriate COVID-19 safety and priority measures are in place.

This guidance has been updated to reflect the current position including the use of necessary tools to ensure that waiting lists are monitored regularly given the current pressures on the NHS, limiting the number of patients who are receiving appointments and treatment. 

The updated version of the framework provides clear guidance on determining a patient’s clinical urgency and sets out review stages to ensure each individual patient’s case is assessed regularly to ensure the most appropriate care and support is provided.


The table below sets out the five key principles that should be considered when clinically prioritising patients:

Access treatment and services in line with clinical prioritisation 

  • a consistent National approach to outpatient, diagnostic and surgical pathways in line with P1 to P4 clinical categorisation (as outlined below). 

Active waiting list management 

  • consistent application of Active Clinical Referral Triage (ACRT) and key indicators for active waiting list management, including addressing demand and capacity issues for each priority level for active waiting list management
  • cross boundary capacity support where patients can be treated out with their own health board area

Patient communication 

  • patients should be communicated with effectively ensuring they have updated information on their treatment and care.

Realistic medicine remains at the core 

  • application of the six key principles of realistic medicine. 

Protection of essential services 

  • maintain essential and urgent services in Critical Care capacity, maternity, emergency services, mental health provision and vital cancer services
  • enabling Boards to demonstrate that the most urgent patients are treated


Waiting Times Team:

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