Commissioning an upper GI endoscopy service

Dyspepsia is a common condition, affecting approximately 40% of the population annually, but only a very few people are likely to have significant morbidity such as gastric cancer.

Benefits

The potential benefits of robustly commissioning an effective upper GI endoscopy service include:

• optimising availability of endoscopy resources for appropriate cases
• ensuring appropriate patients receive endoscopy promptly, in line with national standards - in some areas, this may be reflected by a decrease in the number of inappropriate referrals
• reducing inequalities and improving access
• better value for money, through helping commissioners to manage their commissioning budgets more effectively - this may include opportunities for clinicians to undertake local service redesign to meet local requirements in novel ways.
  

Key clinical issues

Key clinical issues in providing an effective local endoscopy service are:

• Providing effective management of patients with dyspepsia in primary care, in line with NICE clinical guideline CG17 on dyspepsia to ensure that patients receive the most appropriate and effective treatments, and that endoscopies are carried out only when necessary.
• Prioritising referral for endoscopy, especially for those with alarm symptoms detailed in NICE clinical guideline CG27 on referral for suspected cancer.
• Reducing unnecessary referrals- there is a small risk following upper GI endoscopy: in the UK 1 in 200 patients experience adverse events and the risk of mortality is 1 in 2000. However, the mortality for ambulatory patients attending an outpatient endoscopy service is much lower.

National priorities

National priorities and initiatives relevant to upper GI endoscopy include:

• 'World class commissioning'.
• 'The NHS in England: The operating framework for 2009/10'
• Achieving the referral targets for patients with suspected cancer.
• Delivering the 18 week patient treatment pathway and meeting the diagnostic pathway milestones.
• Considering use of the independent sector in providing an upper GI endoscopy service.
• Considering the impact of patient choice.
• Implementation of NICE clinical and public health guidelines. These are currently core standards, and performance against these standards will be assessed by the Care Quality Commission in line with ‘Standards for better health’.
• Meeting targets for key diagnostic service indicators, which are core standards within the Healthcare Commission's annual health check.
  

Although many or all of these priorities may be relevant to the services nationally, your local service redesign may address only one or two of them.