Publication - Advice and guidance

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

Published: 16 Nov 2020

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

Coronavirus (COVID-19): supporting elective care - clinical prioritisation framework
Clinical classification of patients

Clinical classification of patients

Clinical representatives across NHS Scotland have broadly accepted the Federation of Surgical Specialty Association (FSSA) and Joint Royal Colleges of Surgeons’ guidance (see the links at the end of this document).  The two sets of guidance combined formulate the approach that NHS Scotland should take in considering the clinical classification of patients requiring surgical treatment or procedure. 

While this Framework is primarily aimed at surgical patients, it should also be applied to include those waiting for an outpatient appointment or diagnostic testing (including endoscopy and radiology).

During the COVID-19 pandemic patients should be classified in the following groups (as set out in the clinical guidance noted above):

  • Priority level 1a Emergency – operation needed within 24 hours
  • Priority level 1b Urgent – operation needed with 72 hours
  • Priority level 2 Surgery – scheduled within 4 weeks
  • Priority level 3 Surgery – scheduled within 12 weeks
  • Priority level 4 Surgery – may be safely scheduled after 12 weeks.

Review of patients being listed for surgery should be carried out in line with the Priority Matrix set out in Section 3.

To ensure equity of access to radiological investigations, there needs to be agreement on:

  1. Categorisation of urgent elective care imaging which will be prioritised for immediate scanning.
  2. Categorisation of routine elective care imaging, which may require to be placed on hold during periods of decreased scanning capacity.
  • This categorisation will facilitate the order of scanning as soon as scanning capacity allows.
  1. A process for reviewing imaging requests on the ‘on hold’ imaging waiting list.
  • This may involve primary and secondary care teams reviewing requests at agreed intervals with potential for re‑categorisation.
  • Non urgent (remain on waiting list)
  • No longer required (cancel)
  • Urgent (book now/soon)


Waiting Times Team: