Reporting of Virtual Quarterly Outpatient Activity Information

Data Definitions and Guidance Document

Version 2 (March 2026)

1 Background

The Quarterly Outpatient Virtual Activity Return (V-QOAR) relates to total virtual consultant led outpatient activity at each Health and Social Care Trust in Northern Ireland.

On 9 November 2023 the South Eastern Health and Social Care (HSC) Trust launched ‘encompass’ - a new electronic patient record system. The system also went live in Belfast Trust on 6 June 2024, Northern Trust on 7 November 2024 and Southern and Western Trusts on 8 May 2025.

Prior to 2015/16 this information was captured on the Quarterly Outpatient Activity Return (QOAR), but it was increasingly recognised that there was a need to capture virtual activity information separately and a mechanism for recording this needed set up. In April 2015, the former Health and Social Care Board (HSCB) issued technical guidance for the recording of virtual consultant outpatient activity on PAS. Implementation of the virtual activity guidance ensured a regional approach to recoding virtual activity and allowed this virtual activity to be disaggregated from face-to-face activity. This included any associated patient did not attend (DNAs), patient cancellations (CNAs) and hospital cancellations. Subsequently a separate data return for virtual outpatient activity, the V-QOAR, was introduced by the Department in 2015/16.

Any virtual activity data that had previously been included in the QOAR is now recorded on the V-QOAR.

The return is populated by activity data extracted from an encompass report developed by the Department and HSC Trusts. This data is supplemented by any activity not currently recorded on encompass.

Section 1 relates to virtual outpatient attendances, patient cancellations of virtual outpatient appointments (CNA), virtual outpatient appointments which the patient did not attend (DNA), hospital cancellations of virtual outpatient appointments, and virtual outpatient appointments cancelled as the result of a patient’s death.

Further details of the recording of consultant virtual activity on encompass can be found in the Technical Guidance for Recording Consultant Virtual Outpatient Activity.

2 Virtual Activity

Virtual activity is an element of consultant-led outpatient services provided by Health and Social Care Trusts to allow assessment of a patient in relation to a specific condition by a consultant, their staff and associated health professionals.

Virtual outpatient services may be provided at either a designated virtual clinic or at an existing core clinic. Although a consultant is in overall charge of the service, they may not be the one in contact with the patient or their proxy. They must, however, be represented by a member of their team.

A virtual appointment is a planned contact by a consultant responsible for the care of a patient for the purposes of clinical consultation, advice and treatment planning. It may take the form of a telephone contact, video-link intervention, an email or a letter.

Virtual contact between a consultant (or a member of their team) and a patient can be recorded as a Virtual Outpatient Attendance only as long as it replaces what would have been a face-to-face attendance at an outpatient clinic and that it directly supports the diagnosis and care planning of a patient/client. It is not intended to facilitate the recording of every contact/phone call.

Virtual activity is:

Where the patient is referred directly and contact is made with the patient, or the patient’s Proxy virtually via telephone, email, etc. in relation to the patient’s diagnosis, care plan or treatment plan.
Where the patient is referred to an outpatient clinic but following triage by clinical staff, a decision is made that the patient’s appointment can be dealt with virtually as in point 1 above.

Virtual activity is not:

Time set aside to review case notes at a Multidisciplinary Clinic or as part of a multi-disciplinary team setting and no contact is made with the patient.
Where only results or outcomes of MDT clinical review are provided over the phone with no further action.
Where a telephone call is made or an email, text or letter is sent to make an appointment to see the patient or to discharge a patient.

This guidance does not define what is counted as virtual activity in contractual arrangements. However, only virtual activity that is equivalent to a face-to-face contact should be included on the V-QOAR.

Whilst virtual activity will be recorded separately from face-to-face activity, it should be noted that a patient may undergo a sequence of attendances that will involve a combination of the two. Whether these will be counted as new or review attendances will depend on the precise sequence of attendances. The main scenarios (prior to discharge) are discussed in Appendix 2.

3 Definitions

VIRTUAL NEW ATTENDANCE - A virtual new attendance is a virtual appointment with a consultant or their representative following an outpatient referral. In practice, most referrals will be seen as a consequence of a GP referral request; however, referrals may also be received from a range of other sources (see Appendix 1).

A virtual new attendance can occur through an existing core clinic or a designated virtual clinic, and may take the form of telephone, video-link, e-mail or letter contact. In some of these cases the patient will have been notified of the planned contact and given a specified date and time in order to correspond with the consultant (for example, for a telephone or video-link consultation). However, contact between the consultant and patient may sometimes be classed as an ‘attendance’ even if the patient is not in verbal contact with the consultant (for example, through letter or e-mail sent by the consultant).

A virtual appointment that is initiated by the consultant who has already seen the patient, are classified as review virtual attendances i.e. following an attendance at an Emergency Department following an inpatient admission or following a face-to-face outpatient appointment with that consultant.

VIRTUAL ATTENDANCE NEW SEEN - This is the number of attendances at virtual new appointments.

VIRTUAL ATTENDANCE NEW DID NOT ATTEND (DNA’d) - This is the number of patients who did not attend, and failed to give advance warning to the hospital, for a virtual new outpatient appointment. In terms of virtual activity, a nonattendance can be classed if the patient is not available at the specified date and time for the planned contact. This is applicable only if the patient has been made aware of the date and time of the appointment. This includes patients who cancelled their virtual new outpatient appointment on the same day on which the appointment was scheduled. These should not be confused with those who could not attend and who did warn the hospital in advance (before the day on which the appointment was scheduled).

VIRTUAL ATTENDANCE NEW COULD NOT ATTEND (CNA’d) - This is the number of patients who did not attend and gave advance warning to the hospital that they would not be available, for a virtual new outpatient appointment, before the day of the scheduled appointment. These should not be confused with those who either did not attend without prior warning or those who could not attend and informed the hospital on the day on which the appointment was scheduled. This does not include new appointments cancelled as a result of the hospital being notified of the patient’s death.

VIRTUAL REVIEW ATTENDANCES - A virtual review attendance is a virtual appointment with a consultant or a member of their team following; a new outpatient attendance (virtual or face to face), a previous review attendance (virtual or face to face), an attendance at an Emergency Department, a domiciliary visit, or following an inpatient admission, for the same condition. Essentially virtual review appointments are all appointments that are not a first appointment and that take place in a virtual setting.

As with virtual new attendances, virtual review attendances can occur though an existing core clinic or a designated virtual clinic, and may take the form of telephone, video-link, e-mail or letter contact. In some of these cases the patient will have been notified of the planned contact and given a specified date and time in order to correspond with the consultant (for example, for a telephone or video-link consultation). However, contact between the consultant and patient may sometimes be classed as an ‘attendance’ even if the patient is not in verbal contact with the consultant (for example, through letter or e-mail sent by the consultant).

VIRTUAL REVIEW ATTENDANCE SEEN - This is the number of patients who attended a review outpatient appointment. (See Appendix 2 for further information on the categorising of attendance sequence for face to face and virtual appointments).

VIRTUAL REVIEW ATTENDANCE DID NOT ATTEND (DNA’d) - This is the number of patients who did not attend, and failed to give advance warning to the hospital, for a review outpatient appointment. This is applicable only if the patient has been made aware of the date and time of the appointment. This includes patients who cancelled a review outpatient appointment on the same day on which the appointment was scheduled. These should not be confused with those who could not attend and who did warn the hospital in advance (before the day on which the appointment was scheduled).

VIRTUAL ATTENDANCE REVIEW COULD NOT ATTEND (CNA’d) - This is the number of patients who did not attend, and gave advance warning to the hospital, for a review outpatient appointment before the day of the scheduled appointment. This is applicable only if the patient has been made aware of the date and time of the appointment. These should not be confused with those who either did not attend without prior warning or those who could not attend and informed the hospital on the day on which the appointment was scheduled. This does not include review appointments cancelled as a result of the hospital being notified of the patient’s death.

VIRTUAL NEW OUTPATIENT APPOINTMENTS CANCELLED BY HOSPITAL - This is the number of virtual new outpatient appointments that have been cancelled by the provider Health and Social Care Trust. Such cancellations do not include those cancelled by the patient (Could Not Attend), appointments the patient did not attend without giving prior notice (DNA) and new appointments cancelled by the hospital as a result of the patient’s death.

VIRTUAL REVIEW OUTPATIENT APPOINTMENTS CANCELLED BY HOSPITAL - This is the number of virtual review outpatient appointments that have been cancelled by the provider Health and Social Care Trust. Such cancellations do not include those cancelled by the patient (Could Not Attend), appointments the patient did not attend without giving prior notice (DNA) and review appointments cancelled by the hospital as a result of the patient’s death.

PATIENT DIED - This is an appointment which has been cancelled due to the hospital being notified of the patient’s death. Cancellations due to the death of a patient are reported separately in the V-QOAR return and should not be included within the figures for either Patient Cancellations (CNA) or hospital cancellations.

4 Collection Of Data

VIRTUAL OUTPATIENT ACTIVITY

• Virtual activity will be reported by specialty. Prior to encompass the specialty related to the specialty of the consultant that performed the activity and was derived from the consultant’s contract of employment. On encompass the specialty is based on the Department specialty mapped to Treatment Function Code. Therefore, specialties do not match those previously reported. Needs updated to reflect encompass specialties.
• Virtual activity at a consultant led service that equates to a face-to-face contact is counted as a virtual outpatient attendance and should be included on the return. The contact does not necessarily have to be by the consultant themselves for such activity, but it must be by either the consultant or a member of the consultant’s team.
• Virtual activity provided by services not controlled by a consultant e.g. those led by a nurse or Allied Health Professionals should not be included on this return.

• All virtual activity performed by consultants employed by the Health and Social Care Trusts in hospitals in Northern Ireland should be recorded. This includes activity performed as part of ‘in-house’ waiting list initiatives and private patient consultations.

PERIPHERAL OUTPATIENT SERVICES

Not all outpatient services are provided at each of the five HSC Trusts in Northern Ireland. In such circumstances patients from one HSC Trust may attend a service provided at another HSC Trust, or, in other cases, a consultant, or a member of their team, from one HSC Trust may provide a visiting ‘outreach’ service at another HSC Trust. In addition, within an HSC Trust, a consultant may hold services at various locations within their own Trust.

These ‘peripheral’ outpatient services can therefore be:
- regional specialties which are organised centrally but hold outpatient appointments throughout the five Trusts, or
- consultants from any specialty from one HSC Trust that provide a ‘visiting’ outreach service at another HSC Trust.
- consultants from any specialty who may hold services at various locations within their own Trust.

Recording of peripheral services virtual activity must be recorded as that of face-to-face activity. Data should be recorded and returned by the HSC Trust which holds the contract for providing the service. With regional specialties this is likely to be the organising Trust, i.e., in the case of cancer services in the Cancer Centre these are reported by the Belfast Trust. For visiting consultants at another HSC Trust, the contract could be either with the Trust holding the clinic, or with the consultant’s Trust. The same rule applies in both scenarios; whoever has the contract collects and returns the data.

5 Reporting of Data

VIRTUAL OUTPATIENT ACTIVITY

The number of attendances for a virtual new (first) outpatient appointment should be reported in Column B.1 of the return. These include virtual private patient attendances, which are also recorded separately.

The number of patients who did not attend a virtual new outpatient appointment and failed to give advance warning to the hospital (DNA’d) should be recorded in Column C.1 of the return. Patients who could not attend a virtual new outpatient appointment and informed the hospital on the day of the appointment (CNA on the day) should also be reported in Column C.1 of the return. This is applicable only if the patient has been made aware of the date and time of the appointment.

The number of patients who could not attend a virtual new outpatient appointment and informed the hospital before the day of the appointment (CNA’d), should be reported in Column D.1 of the return. This does not include virtual new appointments cancelled as a result of the hospital being notified of the patient’s death.

The number of attendances for a virtual review outpatient appointment should be reported in Column E.1 of the return. These include virtual private patient attendances, which are also recorded separately.

The number of patients who did not attend a virtual review outpatient appointment and failed to give advance warning to the hospital (DNA’d) should be recorded in Column F.1 of the return. Patients who could not attend a virtual review outpatient appointment and informed the hospital on the day of the appointment (CNA on the day) should also be reported in Column F.1 of the return. This is applicable only if the patient has been made aware of the date and time of the appointment.

The number of patients who could not attend a virtual review outpatient appointment and informed the hospital before the day of the appointment (CNA’d), should be reported in Column G.1 of the return. This does not include virtual review appointments cancelled as a result of the hospital being notified of the patient’s death.

The number of virtual new outpatient appointments cancelled by the hospital should be reported in Column H.1 of the return.

The number of virtual review outpatient appointments cancelled by the hospital should be reported in Column I.1 of the return.

The total number of virtual appointments cancelled as the result of the patient’s death, both new and review, should be reported in Column J.1 of the return.

Virtual attendances by private patients are included within the main body of the return but are also separately reported in Column K.1 of the return. The total number of virtual private patient attendances, both new and review, should be reported in Column K.1.

SCHEDULE

HAIB issue a timetable each quarter instructing HSC Trusts to run the encompass report on a particular date. This is usually three weeks after the end of each quarter, allowing HSC Trust administrative staff sufficient time to ensure their outpatient data are recorded correctly on encompass. The timetable also includes the date by which HSC Trusts must submit their V-QOAR return to HAIB each quarter. Sufficient time is given to allow HSC Trusts to run their report, collect data not recorded on encompass, and then populate the V-QOAR return.

6 Data Validation

Each quarter, following receipt of the V-QOAR return from each HSC Trust, HAIB validate the data by comparing figures at Trust and at specialty level for the current quarter and against each of the four quarters of the previous year. Any irregularities are queried with HSC Trusts.

The validation queries are compiled for each of the five HSC Trusts. Trusts are required to provide an explanation for all queries within a week, as well as to confirm figures or provide amendments where necessary.

At the end of each financial year the last quarter’s data is sent out for validation, along with any outstanding queries for the previous quarters of that year and presented to HSC Trusts for final sign-off. Trusts are given two weeks to respond to this.

7 Data Use

Data submitted by HSC Trusts to the DoH on the V-QOAR are Accredited Official Statistics. Accredited Official Statistics are produced to high professional standards set out in the UK Statistics Authority Code of Practice for Official Statistics. They are required to comply with the Code’s core Principles namely Trustworthiness, Quality and Value, including Release Practices.

Provisional data on the number of virtual new attendances are published quarterly in the Northern Ireland Waiting Time Statistics: Outpatients Waiting List Bulletin.

Following final sign off from HSC Trusts, data on virtual new and review attendances, did not attends and cancellations, is then published in the annual Hospital Statistics: Outpatient Activity Statistics report. The most recent publication, together with previous editions, can be found at the following link:
https://www.health-ni.gov.uk/articles/outpatient-activity

Virtual Outpatient activity data split by financial year, HSC Trust and specialty are also published in Microsoft Excel format at the above link.

Virtual Outpatient activity data are also used in:

• Ministerial answers to both Written and Oral Assembly questions.

• Departmental responses to correspondences received from the NI Assembly Health Committee, Public Accounts Committee, Northern Ireland Audit Office and other stakeholder bodies such as the Patient Client Council.

• Ministerial briefing material.

• Health compendium publications.

• Responses to data requests from HSC, politicians, journalists, voluntary/charitable organisations and members of the general public.

8 Contact Details

This document will be reviewed and updated periodically. Frequently asked questions can be found in Appendix 1.

If you have any issues relating to the contents of the document or the collection of outpatient activity information in general please contact:

Hospital Activity Information Branch
DoH
Annex 2, Castle Buildings
Stormont
Tel: 028 90522521
E-mail:

APPENDIX 1: Frequently Asked Questions

What are the main sources of referral for a first outpatient appointment?

While the majority of referrals for a first outpatient appointment will be made by a General Practitioner, referrals may also be received from a range of other sources. A full list of the sources from which a referral for a first outpatient appointment may be received is outlined below.

• General Practitioner / General Dental Practitioner, including referrals submitted via the Clinical Communications Gateway (CCG)

• ICATS following triage, i.e. where a patient is initially referred by their GP for an ICATS service, but at the paper triage stage it is decided that the patient is not suitable to be treated by ICATS and needs to be seen by a consultant. The patient will be referred as a GP referral
• Emergency Department (not initiated by same consultant to whom the patient is being referred)
• Other consultant (other than Emergency Department)
• Self-referral
• Prosthetist
• Another Health Practitioner
• Family Planning Service
• Voluntary Agency
• Criminal Justice Agency
• Screening Service
• ICATS following a diagnostic test or treatment

Does only activity that takes place in a designated virtual clinic be recorded on the V-QOAR?

No. A virtual appointment may take place at an existing core clinic or at a designated virtual clinic. The relevant Appointment Type Codes will be used to indicate a virtual appointment, and the appropriate attendance outcome code to indicate that the patient has been contacted virtually.

Should virtual activity not recorded on PAS be reported on this return?

Yes. All virtual activity should be included on this return.

Should nurse led virtual activity be reported on this return?

No. This return relates solely to virtual activity performed at a consultant led outpatient service. Activity performed at a non consultant led service, such as those led by nurses, allied health professionals etc. should not be reported on this return.

Does the virtual contact have to be between the consultant in charge of the team and the patient in order for their attendance to be reported on the return?

Not necessarily. In order for the attendance to be recorded as a virtual outpatient attendance, the patient should be seen by either a consultant or a member of a consultant led service. For example, if the patient is contacted by a nurse in a service that is under the overall control of a consultant, this activity should be reported on this return. If on the other hand, the patient is contacted by a nurse who is not working as part of a consultant led team, the service is considered to be nurse led and should not be reported on this return.

Does the patient have to speak to the consultant (or member of their team) for it to be counted as a virtual attendance?

Not necessarily. A virtual attendance can be prearranged contact between the patient and consultant (or a member of their team) via telephone or video link. Such contact allows discussion between the patient and consultant. However, a letter or e-mail can also count as a virtual attendance, but only if it replaces what would have been a face-to-face attendance at an outpatient clinic and it directly supports the diagnosis and care planning of a patient. Therefore, though an e-mail or letter can be counted as a virtual attendance, it is not necessarily the case that every such contact should be counted as virtual activity. It is important that all HSC Trusts adhere to this, as any misuse may result in the guidance being reviewed.

Does a virtual attendance stop a wait for a new appointment?

Yes. A virtual new attendance will be counted as ending a patient’s outpatient wait. However, the virtual activity that took place must be the equivalent of any face-to-face appointment that would have taken place. The impact of virtual activity on the outpatient waiting list will be monitored by the Department.

Does virtual activity include a consultant being asked for advice over the phone for a patient in the Emergency Department?

No. This is not counted as virtual activity and so should not be included on this return.

Can contact with a relative/carer be considered a Virtual Appointment?

Yes. This is considered as a proxy and so can be counted as a virtual attendance and included on this return.

Can the patient’s GP act as the proxy in a virtual setting?

No. The patient’s GP should not be able to act as the proxy.

APPENDIX 2: CATEGORISING OF ATTENDANCE SEQUENCE FOR VIRTUAL AND FACE TO FACE APPOINTMENTS

Following referral, a patient may be triaged to a core or a designated virtual clinic for a virtual new appointment. This will be recorded on the V-QOAR as a virtual new attendance. The patient may then be given a virtual review appointment, which will be recorded on the V-QOAR as a virtual review attendance. Any subsequent virtual attendances will also be recorded as virtual review attendances on the V-QOAR.

Virtual new → Virtual review → Virtual review

V-QOAR → V-QOAR → V-QOAR

Following referral, a patient may be triaged to a core or designated virtual clinic for a virtual new appointment. This will be recorded on the V-QOAR as a virtual new attendance. However, following this virtual new attendance it is decided that the patient requires a face-to-face appointment. This will be recorded on the QOAR as a review attendance. Any subsequent face to face attendances will also be recorded on the QOAR as review attendances.

Virtual new → Face to face review → Face to face review

V-QOAR → QOAR → QOAR

As (ii) but following the review face to face attendance that is recorded on the QOAR, the patient is given a virtual appointment. This will be recorded on the V-QOAR as a virtual review attendance.

Virtual new → Face to face review → Virtual review

V-QOAR → QOAR → V-QOAR

Following referral, a patient is triaged to a clinic for a face-to-face appointment. This will be recorded on the QOAR as a face-to-face attendance. Following this face-to-face attendance the patient is given a virtual appointment. This will be recorded on the V-QOAR as a virtual review attendance. Any subsequent virtual review attendances will also be recorded as virtual review attendances on the V-QOAR.

Face to face new → Virtual review → Virtual review

QOAR → V-QOAR → V-QOAR

As (iv), but following the virtual review attendance, the patient is given a face-to-face appointment. This will be recorded on the QOAR as a review attendance.

Face to face new → Virtual review → Face to face review

QOAR → V-QOAR → QOAR

As well as the scenarios above, if patients have multiple review appointments, these could switch between virtual and face to face appointment types. Therefore, care must be taken to record this appropriately. Further information is given in the flowcharts that follow.