Ensuring corporate and quality assurance
Commissioners should ensure that the services they commission represent value for money and offer the best possible outcomes for patients. Commissioners need to set clear specifications for monitoring and assuring quality in the service contract.
Commissioners should ensure that they consider both the clinical and economic viability of the service, and any related services, and take into account patients´ views and those of other stakeholders when making commissioning decisions.
Any upper GI endoscopy service needs to:
- Monitor the proportion of endoscopies carried out within diagnostic waiting time targets - this should be defined as:
- where there is a locally agreed 'straight to test' pathway for urgent GP referrals for suspected cancer, then within a minimum two week wait from referral
- where the urgent GP referral for suspected cancer was to a upper GI clinic, which has led to a referral for endoscopy, as soon as practicable, with regard to meeting the total 62 day urgent GP cancer referral treatment pathway
- for all other referrals, within the 18 week patient pathway.
- Audit cases against the referral criteria (see NICE clinical guideline CG17 on dyspepsia Appendix D) to ensure that inappropriate patients are not being investigated within the service. This will be an important component of managing demand.
- Demonstrate how it meets requirements under equalities legislation.
- Demonstrate value for money.
Suggested steps to facilitate audit and improve quality of referral are: use of agreed form, referral policy, education before referral and advisory feedback for referrals that do not adhere to agreed policy.
Local quality assurance
Any mechanisms for assurance at a local level are likely to refer to the following:
- Service targets: estimated caseloads, complaints procedures.
- Audit arrangements: frequency of reporting, reporting route and format and dissemination mechanisms.
- Clinical quality criteria: appropriateness of referral, waiting times and procedures for obtaining consent. Use of the global rating scale for endoscopy (see below) will support this.
- Patient outcomes.
- Equipment: testing and calibration.
- All upper GI endoscopy units should work towards Joint Advisory Group accreditation.
- Information requirements, including both patient-specific information (NHS number, referring GP) and service-specific information (referral-to-treatment times, workload trends, number of complaints).
- The process for reviewing the service with stakeholders, including decisions on changes necessary to improve or to decommission the service.
- Achieving targets associated with equalities legislation.
General information on quality and corporate assurance can be obtained from the following sources.
- The National Patient Safety Agency (NPSA) oversees the implementation of a system to report and learn from adverse events and near misses occurring in the NHS. The publication 'Seven steps to patient safety' provides an overview of patient safety and gives updates on the tools that the NPSA is developing to support patient safety across the health service.
- NHS Alliance online resources. NHS Alliance is the representational organisation of primary care and primary care trusts, and provides them with an opportunity to network and exchange best practice. The alliance supports its members with an open-access helpline, in-house and joint publications and briefings, internal newsletters and a website.
- The DH commissioning framework provides guidance on the commissioning process in the context of the NHS reform agenda.
- Delivering the 18 week patient pathway provides a range of resources to support the key NHS objective to deliver an 18 week patient pathway from GP referral to the start of treatment by the end of 2008.
- NHS Institute for Innovation and Improvement support for commissioners, includes Commissioning for Health Improvement products to accelerate the achievement of world class commissioning; The Productive Leader programme to enable leadership teams to reduce waste and variation in personal work processes, and Better care, better value indicators to help inform planning, to inform views on the scale of potential efficiency savings in different aspects of care, and to generate ideas on how to achieve these savings
- '10 Steps to your SES: a guide to developing a single equality scheme'.This guidance has been developed to assist NHS organisations that have a duty, as public authorities, to comply with the race, disability and gender public sector duties, and in anticipation of new duties in relation to age, religion and belief, and sexual orientation.
Specific information on quality and corporate assurance for an upper GI endoscopy service can be obtained from the following sources.
- The Global rating scale for endoscopy is a tool to support endoscopy services by assessing how well they manage a patient-centred service. This is achieved by the provision of an audit tool for self assessment.
- Endoscopy quality and safety indicators is a document that contains the quality and safety indicators for endoscopy services developed by the British Society of Gastroenterology. The indicators are grouped into auditable outcomes and quality standards, which can be used by services to monitor the clinical care they provide.
- The Cancer services collaborative improvement partnership (CSC'IP') is a national NHS-funded programme designed to drive improvements in the way cancer services are delivered to patients. The programme is designed to provide a practical approach to support local clinical teams to look at their own services and make significant improvements for patients by redesigning the way that care is delivered. The upper GI cancer section includes service improvement guides, top tips and examples of upper GI pathways.
- The Primary Care Society for Gastroenterology (PCSG) is a network for general practitioners and others interested in all clinical, research and educational aspects of gastroenterological disorders, and in particular their management in primary care.
- The Healthcare Commission report Taking a closer look: Endoscopy services in acute trusts presents the key national findings of a review of gastrointestinal endoscopy carried out in NHS acute hospitals in England, and offers recommendations for trusts, clinicians and commissioning bodies.
This page was last updated: 11 May 2010