Reports from the chair of clinical services and audit

Mr Nicholas Maynard
Chair of Clinical Services and 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.

June 2016

The NOGCA 2015 Annual Report and 2015 Consultant Outcomes publication were successfully released at the end of last year, and work is well under way with the 2016 report. In the future we will be including more data on pathological outcomes of surgery (resection margins and nodal yield) and surgical complications. At a recent meeting of the Leads of all the National Clinical Audits, Sir Bruce Keogh, Medical Director of NHS England, made it absolutely clear that there remains a strong political mandate from the Department of Health to continue to report outcomes at an individual Consultant level. We will, of course, in our reporting, continue to emphasise the importance of team working and unit based outcomes. There was much discussion about future funding of these audits and although we have secured funding for NOGCA until 2022, there is no certainty of funding beyond then and there is no prospect of any additional audits being funded. A challenge for AUGIS will be how to fund our OG, HPB and bariatric audits in the future.

The updated AUGIS Provision of Services Document is now finished. Much hard work has gone into this document and it will, for the first time, describe required Standards of Care for all forms of Upper GI surgery (cancer and benign), not only with respect to who should be carrying out such surgery and minimal acceptable volumes of work, but also with respect to acceptable outcomes of such surgery. These standards will of course evolve, and we anticipate that this document will be regularly updated.

We are currently revising the Commissioning Guidelines for the Royal College of Surgeons on Gallstone Disease and Reflux Disease and, in due course, this will be published on both the College and AUGIS websites.


February 2016

The NOGCA 2015 Annual Report is due to be published as is the latest Consultant Outcomes data.Data collection for the 2014/15 NOGCA submissions is nearly finished with the new final deadline for data submission having been extended to January 2016. The data set is slowly expanding and in the future is anticipated to include more on pathological outcomes and complications of surgery.

Work is well underway on the revision of the AUGIS Provision of Services document. This will cover the nature of Upper GI Disease, the necessary components required for an Upper GI Surgical Service and detailed descriptions of specialist Oesophago-Gastric, Hepato-Pancreato-Biliary and Bariatric Surgical Standards.

It will also describe required Standards of care for all forms of Upper GI surgery (cancer and benign), not only with respect to who should be carrying out such surgery and minimal acceptable outcomes of such surgery.

The first draft is nearly finished and due to be presented to Council.


August 2015

The NOGCA 2015 Annual Report 2015 Consultant Outcomes publication will be out soon and will include two year’s worth of data, including patients diagnosed between April 1, 2012 and March 31, 2014. All members of AUGIS will know that the NOGCA would not have happened without the huge amount of work that Richard Hardwick has put into the development and continuing maintenance of the Audit and, more recently, the publication of Consultant outcomes. Richard is stepping down as Surgical Lead of NOGCA and, as the Chair of Clinical Services and Audit committee, I will take over this role. I would like to take this opportunity to thank Richard for all his hard work.

The working party convened with ASGBI and ACPGBI has successfully produced a joint document on The Future of Emergency General Surgery and this is now available on the ASGBI website. We very much hope that Trusts will use this document as a guide to help the development of Emergency General Surgery in acute hospitals, and also to ensure adequate training in emergency upper and lower GI surgery.

Over the next 12 months we will be updating the AUGIS Provision of Services Document, last produced in 2011. As before this will cover the nature of Upper GI Disease, the necessary components required for an Upper GI Surgical Service and detailed descriptions of Specialist Oesophago-Gastric, Hepato-Pancreato-Biliary and Bariatric Surgical Services Services.

It will also describe required Standards of Care for all forms of Upper GI surgery (cancer and benign), not only with respect to who should be carrying out such surgery, but also with respect to acceptable outcomes of such surgery.