Ensuring that endoscopy services are operating efficiently to maximise capacity is a key part of JAG accreditation. The below document suggests several initiatives that services should implement to ensure that patients continue to receive their endoscopy in a timely fashion.
In reviewing referral pathways to ensure efficiency, organisations should also consider and review:
- Upper and lower GI pathways to ensure that they are clinically agreed and timely
- Whether CTC provision is optimised where available and appropriate
- Vetting processes are agreed with STP and CCG (England only). Sharing responsibility for refusing inappropriate referrals
- Plan for changes in demand including BCSP. Ensure that the organisation has a clear capacity business development plan that has the support of the relevant CCG (in England only).
Getting it Right First Time (GiRFT)
The NHS Improvement programme, Getting it Right First time (GiRFT) aims to reduce variation in outcomes and resource utilisation and therefore improve quality of care. Through 2019 and 2020 it is providing trusts specific feedback on a variety of key indicators. derived from hospital episode statistics (HES) and other national data sources cancer registries. JAG recommends the data presented to each trust is used to further inform their endoscopy quality improvement by reviewing referral pathways and appropriateness of alternative provision such as CTC (Computed tomography (CT) colonography).
Previous studies demonstrated that validation exercises could significantly impact surveillance waiting lists. Many services are already addressing this issue by regularly and prospectively validating lists and through other innovative initiatives. These processes now need to be adapted and supported with additional clinical resource to implement the full potential impact of the latest guidance. The 2019 guidelines are expected to reduce demand for surveillance procedures by up to 70% and are a positive development in reducing demand on services. Services will be able to safely identify patients who can have their surveillance period extended or who can be discharged to FIT screening or back to their GP. JAG strongly recommends this process is embarked on promptly to maximise effect and prevent unnecessary endoscopy. Teams should be adequately resourced to carry out robust validation. A lay summary which can be given to patients is included in the guideline (appendix 4).
The criteria for an urgent two week “non-cancer” referral for endoscopy should be reviewed and clearly defined by services. Many referrals made under this criteria may not require an appointment within 2 weeks and so there is the potential to increase immediate capacity and increase flexibility. Furthermore, many organisations no longer use this category and so organisations still using it may want to consider its value and appropriateness.
It is ultimately for hospitals locally to determine the appropriate arrangements for each individual patient, but this must consider achieving the best clinical outcomes for patients. This includes complying where appropriate with NICE quality standards and evidence-based guidelines and following a risk stratification approach as outlined above.
Services should work with their endoscopy clinical lead and senior management team to ensure all options for improved management of waiting times and validation of surveillance cases are implemented. Sustaining a low wait service is a key factor in providing high-quality and responsive care to patients and in achieving and maintaining JAG accreditation.
The following resources may be of use: