Specifying an upper GI endoscopy service
Service components
The key components of an effective upper GI endoscopy service are:
- ensuring appropriate management of dyspepsia within primary care
- developing a high-quality endoscopy service.
Appropriate management of dyspepsia within primary care
This commissioning guide does not describe the appropriate management of dyspepsia within primary care. However, it is clearly an important step towards managing the flow of patients for endoscopy.
Local organisations might wish to develop protocols for referral and management of patients with symptoms of dyspepsia based on the NICE clinical guideline CG17 on dyspepsia and CG27 on referral for suspected cancer.
Ensuring the appropriate patients are referred for endoscopy is important in managing demand. See a summary of NICE endoscopy referral criteria.
Developing a high-quality endoscopy service
Existing NICE guidance does not address what is required of an endoscopy service. Further information on detailed requirements can be found at the NHS endoscopy site and the global ratings scale.
The British Society of Gastroenterology has published quality and safety indicators for endoscopy. When establishing an upper GI endoscopy service it is important to consider the skills of the operator, because this can have a significant impact on service quality.
Local stakeholders, including service users should be involved in determining what is needed from an upper GI endoscopy service in order to meet local needs.
The service specification needs to consider:
- the number of patients expected to use the service (this should take into account how quickly expected changes in provision are likely to take place)
- the provision of Helicobacter pylori (H.pylori) testing (stool test or breath test)
- the timeframe for expected changes to service provision to occur
- ease of access and ability to meet the 2-week referral target for suspected cancer
- location of the service
- information requirements
- service monitoring criteria.
The only available guidance on the annual number of endoscopies that a practitioner should perform to ensure safe clinical practice is from the Joint Advisory Group on gastrointestinal endoscopy. The group advises that a practitioner should perform a minimum of 200 procedures annually; however, it must be emphasised that this figure is only a professional opinion and is not based on definitive evidence.
Useful sources of information may include:
- Delivering the 18 week patient pathway: 18 week commissioning pathways.
- The Map of medicine provides an information resource that visually organises the latest evidence and best practice guidelines.
- The NICE shared learning database offers examples of how organisations have implemented NICE guidance locally.
This page was last updated: 11 May 2010
- Upper GI endoscopy services
- Commissioning an upper GI endoscopy service
- Specifying an upper GI endoscopy service
- Determining local service levels for an upper GI endoscopy service
- Assumptions used in estimating a population benchmark
- The commissioning and benchmarking tool
- Ensuring corporate and quality assurance
