Reports from the chair of clinical services and audit

January 2018

Mr Nicholas Maynard
Chair of Clinical Services and Audit

The National Oesophagogastric Cancer Audit is the largest audit of OG cancer care worldwide, and similarly the National Bariatric Surgery Registry is established as one of the most comprehensive audits of outcomes from bariatric and metabolic surgery in the world. A significant proportion of the work done by our members, however, is outwith these two specialities, and we need to audit HPB cancer surgery and non-bariatric upper GI surgery in a similar way. Ian Beckingham has developed a robust and accurate database based on HES data for our most commonly performed operations, the Surgical Workload Outcomes Audit Database (SWORD). These databases provide comprehensive activity data, and also important but limited outcome data.

As we develop specific outcome standards for all the operations we do, there will be an increasing need to collect this ever more detailed outcome data, not only to satisfy increasing public demand, but also to ensure the surgery is being carried out throughout Great Britain and Ireland to a consistently high standard. Together with the OG, HPB and Bariatric leads we will be working towards refining these standards and developing existing and new platforms for collecting this data.

June 2017
The last six months have been reasonably quiet for Clinical Services and Audit following a busy couple of years. The NOGCA 2016 Annual Report and 2016 Clinical Outcomes Publication were published successfully, with no outliers. We are now collecting data on resection margins and lymph node yields, and in the 2016 report we gave some preliminary baseline information. These two indicators will be included in the 2017 report as outcome measures, and it is expected that in due course they will provide us with good measures of quality of surgery.

The current audit has been given a one year extension to end of May 2018 and, although NHS England will recommission the audit, it has confirmed that it will do so in a joint audit with the bowel cancer audit – a three year National Gastrointestinal Cancer Audit Programme. A specification development meeting will take place soon and we hope that the oesophagogastric part of the joint audit will continue along similar lines to the existing audit.

January 2017
The updated AUGIS Provision of Services Document is now on the AUGIS Website and the core contents were presented at the AUGIS Annual meeting in Leeds in September 2016. For the first time we are describing required Standards of Care for all forms of Upper GI surgery and these standards will be updated on a regular basis. We have also revised the Commissioning Guidelines for the Royal College of Surgeons on Gallstone Disease and Reflux Disease.

A major project over the next year will be to update all the Clinical Terms (for diseases and procedures), which relate to our specialties that are used in SNOMED (Systemized Nomenclature of Medicine) on behalf of NHS Digital and the Royal College of Surgeons. This will take some time, but is long overdue and hopefully will banish to the archives some of the historical procedures we still see recorded in coding systems and manuals.

As in previous years the NOGCA 2015 Annual Report and 2015 Consultant Outcome Publication were published with no minimal noise and no outliers. Work is well underway with the collection and submission of data for the NOGCA 2016 Annual Report and 2016 Consultant Outcomes publication. We will hopefully include more primary care data about what happens to patients before they arrive in secondary care, and also more data about chemotherapy and radiotherapy received by our patients.