Reports from the chair of clinical services and audit

January 2019

Iain Cameron
Lead for Clinical Services, Audit and Corporate Partnerships

It is now just over two months since I took over from Nick Maynard as Clinical Services and Audit lead and I have now attended my first AUGIS executive council meeting. I was really impressed with the plans discussed for the coming two years including the Liverpool meeting in September and the multi-speciality joint meeting in October 2020.

From the Clinical Services perspective we are due to update the AUGIS clinical services document in 2019, three years after the last version was published, to reflect the ongoing evolution of all aspects of Upper GI surgery. I am hoping to coordinate this project with involvement from the Presidents of BOMSS and GBIHPBA, plus James Gossage, our newly-appointed AUGIS Upper GI cancer lead. I am intending to consult widely and take soundings from many AUGIS members, before producing the final document in Autumn.

From the Audit perspective, the well-established NOGCA and Bariatric audits are continuing to collect data and the issue of the lack of a national audit for any aspect of HPB surgery will be revisited. Much of the ongoing work in coordinating these audits will reside with the relevant sub-specialty lead and myself.

In my new role I have also been asked to take the lead for the continued development of the current AUGIS partnerships with our industry sponsors, which provide a vital financial stream allowing our organisation to continue in its current form. A detailed review of our relationship with all our key sponsors will begin soon and a series of meetings will evaluate how these partnerships could evolve.

The final initiative that I am very keen to support will be our drive to ensure a series of high quality AUGIS meetings delivered at regional level, ideally to coincide with deanery HST teaching days. The Executive council is really keen to support this programme and will encourage local representatives to organise and deliver a regional AUGIS meeting within the next 12-18 months.

July 2018

Mr Nicholas Maynard
Chair of Clinical Services and Audit

I am delighted to report that the Clinical Effectiveness Unit at the Royal College of Surgeons has been awarded the contract to continue the excellent work it has been doing since 2008 in running NOGCA. As I mentioned in a previous newsletter NHS England have recommissioned the audit in a joint audit with the bowel cancer audit – a three year National Gastrointestinal Cancer Audit Programme. We anticipate little change in the format of the audit, but will be hoping for ever more robust data from the new outcome measures we have introduced. We are nearing the end of the first five-year cycle of the second NOGCA audit and we will now be able to publish five year outcome data.

We have collected a huge amount of data, and this will enable us to carry out some very interesting analyses of outcomes comparing, for example, minimally invasive versus open approaches for surgery, and different neoadjuvant chemotherapy and chemoradiotherapy regimes.

Over the next 6 to 9 months we will be updating the Provision of Services Document with specific reference to outcomes and minimum standards, and also will be looking at ways of collecting robust outcomes data on the benign work we do. This will be a challenge but we have to ensure that we monitor outcomes and apply similar quality standards to our benign work as we now do so transparently to our cancer work.

January 2018

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.