This guidance describes levels of surgical priority, covering all surgical specialties with the exception of obstetrics and gynaecology and ophthalmology. Prioritization for thèse disciplines will follow.

Patients requiring surgery during the COVID-19 crisis have been classified in the following groups:

Priority level 1a Emergency - operation needed within 24 hours Priority level 1b Urgent - operation needed with 72 hours
Priority level 2 Surgery that can be deferred for up to 4 weeks Priority level 3 Surgery that can be delayed for up to 3 months Priority level 4 Surgery that can be delayed for more than 3 months

These time intervals may vary from usual practice and may possibly result in greater risk of an adverse outcome due to progression or worsening of the condition, but we have to work within the resources available locally and nationally during the crisis.

For those involved in the planning and delivery of cancer services, specific guidance is available: www.england.nhs.uk/coronavirus/secondary-care/other- resources/specialty-guides/#cancer

For guidance on organ transplantation services please refer to www.england.nhs.uk/coronavirus/secondary-care/other-resources/specialty-guides/

The current guidance is designed primarily to assist a variety of professionals involved in the care of surgical patients. This categorisation will help:

• managers to plan the allocation of surgical resources

• individual surgical specialties to appreciate the needs of other specialties

  when resources are stretched

• facilitate the development of regional surgical networks to sustain the delivery

  of surgery in a timely fashion.

  It is imperative that patients do not get lost in the system. Clear records of patients whose care is deferred must be held and co-ordinated.

  In time, understanding the extent of work that has been deferred will help with planning the measures that need to be taken to reduce the inevitable increase in waiting times and the size of waiting lists that will occur in all surgical specialties.

  Please note: Any delay in treatment, especially of cancers, trauma and life- threatening conditions, may lead to adverse outcomes.