Shared learning database

NHS Plymouth
Published date:
January 2011

The inclusion of a proposal for the provision of audit reports relevant to 2 areas of NICE guidance in the local Clinical Governance Development Plan, provides clarity for GPs and Commissioners in the expectations for the delivery of NICE Assurance. The audit reports reflect current practice, allowing necessary changes to take place within a mutually agreed timeframe.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of this initiative was to imbed the provision of NICE assurance into existing audit activity across the local GP community, allowing practices to deliver robust evidence to demonstrate the continued implementation without overwhelming practice resources. - To build on existing audit activity across the Primary Care Community in Plymouth. - To provide a formal agreement in the provision of NICE Assurance in General Practice. - To deliver Primary Care audit reports in a standardised, user-friendly way, allowing for easier collection and interpretation of data. - To increase visibility of any variance in practice across practices allowing Primary Care. - Managers to take remedial action. - To provide robust assurance of NICE compliance for trust. - Commissioning boards. - To increase opportunities for professional development in practices.

Reasons for implementing your project

The NHS Plymouth Clinical Governance Development Plan for Primary care includes a requirement that GPs provide audit data to support a declaration of compliance with NICE guidance at practice level. Documented evidence to demonstrate NICE Assurance has been historically difficult to acquire within the trust - through this programme data is being built up as part of the NICE Assurance programme. Participating practices are required to carry out 2 audits relating to NICE guidance and submit an audit report. The audits would also be an achievable way for practices to provide evidence to support clinical governance and NICE Assurance.

How did you implement the project

Clear expectations were discussed at the Primary Care Governance forum and then negotiated with GPs to ensure that practices could commit to this audit program. Following inclusion of NICE audit, the Clinical Governance Development Plan was formally agreed at the Primary Care Governance Forum and Commissioning Governance Committee. It was then introduced to practices at the Practice Managers Away Day. The trust audit team were consulted on the development of an audit template and links to the audit tools of recommended NICE topics were sent to practices. Telephone support was also provided by the NICE Assurance manager and several practices required guidance in how to access the NICE audit tools. Guidance documents, a PowerPoint presentation, an audit template, telephone and email support were offered to all practices to ensure the continued improvement in NHS Plymouth audit submission. There was an agreed expectation that records of at least 30 patients should be reviewed unless the total number of patients involved was less that 30 e.g. patients with Familial Hypercholesterolaemia (CG71).

Key findings

84% of Plymouth practices participated in the 2009/10 program; submitting audit reports covering 20 areas of NICE guidance. (Chronic Kidney Disease, Type 2 Diabetes and Stroke were particularly popular). Practices are sent a list of NICE guidance topics of the last year that they might like to choose for their audit. On submission, all audit reports were assessed by the NICE Assurance Manager under the following (weighted) criteria with a maximum possible score of 100: 1. Was the NHS Plymouth template used? (10 points). 2. Was the appropriate NICE audit tool used? (20 points). 3. Was all identifiable patient information removed from the audit report? (20 points*). 4. Were the aims and objectives of the audit clear? (10 points). 5. Was the audit methodology clear? (10 points). 6. Did the audit report reach appropriate conclusions? (10 points). 7. Did the report outline an appropriate action plan? (20 points*). *Automatic failure resulted if this criterion was not met. Nearly two thirds of the audits received met the expectations in the provision of evidence to support compliancy, or indentifying current deficiencies in compliancy with NICE and mitigating action to be taken. Through the use of a standard template, results of audits of the same area could be compared and helped provide added assurance. NICE topics covered by more than one practice include Stroke (CG58), Attention Deficit Hyperactivity Disorder (CG72), Familial Hypercholesterolaemia (CG71), Primary Prevention of Osteoporosis (TA160), Chronic Kidney Disease (CG73), Lipid Modification (CG67) and Diabetes (CG66). Following review of their audit, each practice was contacted and advised of their performance against the agreed criteria. Practices were particularly interested to know how their scores compared with submissions overall and whether their scores fell above or below average.

Key learning points

1. Avoid Assumptions - Practices were originally considered to have experience in audit. However, initial submissions showed a huge variance in audit quality. 2. Provision of an audit template - The development of an audit report template served to guide practices through their submission, set a clear benchmark for the standard required and made interpretation of the audit data more straightforward. 3. Establish minimum requirements - Audit reports were assessed against 7 pre-agreed criteria (listed above). Practices were required to submit an action plan and eliminate all patient identifiable data to avoid automatic failure of their submissions. 4. Negotiation / 'Buy in' - expectations of the audits submitted were previously agreed with practices and then agreed at the Primary Care Governance Forum. This exercise was not about re-inventing the wheel. Additional work was not required by practices, but simply a different approach to existing activities. 5. Mutual Benefit - Practices could choose areas for audit that were relevant to them and use the audit report to drive local service improvement. Submitted audits could also be used as evidence to support NICE Assurance. 6. Compromise - It was acknowledged that a full audit involving large numbers of patients would have been outside the scope of most practices. Therefore, practices could choose whether to audit a random sample of records of 30-50 relevant patients against all of the NICE audit criteria or select 3-5 NICE audit criteria and use them to audit all relevant patients. 7. Constructive feedback - Each practice received individual feedback on their audit submission with recommendations for improvement. Practices have on the whole, taken these recommendations on board for their 2010 submissions. A feedback document covering the overall performance of participating practices was also distributed widely. Three practices were given particular recognition for the best quality audits submitted.

Contact details

Emily Faircloth
NICE Assurance Manager
NHS Plymouth

Primary care
Is the example industry-sponsored in any way?