Clinical

Commissioning report

The commissioning guidance has been produced in partnership with professional and patient associations – BAPEN, BASL, the IBS Network, Crohn’s & Colitis UK, Coeliac UK, British Liver Trust and the BSG. It sets out the key elements of a good gastroenterology and hepatology service according to the key aspects of the NHS Outcomes Framework. The main summary report is just 15 pages. It draws upon more detailed analyses of care pathways which are also available in pdf form on these pages. We intend to update the website regularly.

Many hospitals not reaching national standards for treating IBD despite improvements in services

Care for patients with Inflammatory Bowel Disease (IBD) has improved since 2008, according to the third UK IBD Audit, but many hospitals are still not reaching the National IBD Service Standards, launched in February 2009.

The Royal College of Physicians has issued a press-release to publicise data from the Audit's third round and the efforts being made nationally to adopt the Standards:

NPSA Safety Alert: Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants

This Alert updates and strengthens Patient Safety Alert 05 (Reducing the harm caused by misplaced nasogastric feeding tubes) and is based on national learning since then.

The Alert must be actioned by all organisations in the NHS and independent sector where nasogastric feeding tubes are placed and used for feeding patients. An executive director, nominated by the chief executive, working with relevant medical and nursing staff should ensure, through reviewing policies, procedures and staff training that by 12 September 2011 they have met the six objectives highlighted in the Alert. These are described in full on the NPSA website.

New guidance to stop people dying from acute gastric bleeding

The CROMES Project: 'Scope for Improvement: A toolkit for a safer Upper Gastrointestinal Bleeding (UGIB) service'

A BSG led UK-wide audit in 2007 highlighted significant deficiencies and inconsistencies in service provision and care of patients presenting with UGIB. The BSG, under Kel Palmer's stewardship, undertook a piece of research, initiated under the title of Consultant Rota On-call Modelling of Endoscopy Services (CROMES).

The BSG has worked with the Royal College of Physicians, Royal College of Radiologists, National Patient Safety Agency and Royal College of Nursing to develop a toolkit to provide practical support to providers and commissioners to consider changes to their UGIB services to help improve the quality of care and outcomes for patients with UGIB. The Toolkit may be downloaded below from the AOMRC website:

BSG Response to 'Equity and Excellence: Liberating the NHS' - The White Paper

The British Society of Gastroenterology (BSG) welcomes the emphasis in the White Paper given to clinical outcomes, the ambition to improve the quality of services, the emphasis placed on clinically-led commissioning, and recognition of the need for clinical leadership. We have some specific anxieties regarding (i) the relative lack of focus on outcomes relevant to gastrointestinal and liver diseases, several of which are major causes of suffering, loss of earnings and mortality in relatively young people, (ii) the practicalities of ensuring appropriate involvement of relevant specialists in commissioning across a large number of GP consortia, (iii) the lack of any reference to the importance of secondary care prevention (for example alcoholism where patients make contact with secondary care often via A and E, (iv) the potential for GP commissioning to act as a permanent reinforcement of the gatekeeper role of general practice, sometimes resulting in delay and poorer outcomes eg in cancer.

The BSG has joined with the British Liver Trust and BASL to submit a special response on liver disease.

Both consultation responses can be read below:

A Note on Clinical Coding – On Behalf of the BSG IPC

Members in private practice will be aware of the need to accurately assign procedure codes when they submit invoices for payment to private medical insurers in the UK.

These codes were originally developed by BUPA, and were loosely based on NHS codes though their purpose was simply to help with reimbursement arrangements. Codes used by the NHS focused on activity and epidemiology rather than financial flows though with the development of Payment By Results and 'tariff', NHS coding needs are changing.

Several private medical insurers are now working together to maintain and develop a consistent coding schedule. They work together as the Clinical Coding Schedule Development (CCSD) group. They respond to developments in clinical practice by assigning new codes where existing codes cannot capture the complexity of a new procedure. The group does not dictate fee levels, decisions about which remain with the individual insurers. Although some private medical insurers are not members of CCSD, they all make use of the group's output. The codes may be built into commercially-produced private practice management software too.

Survey of Hepatology Service Provision 2010

In 2004 Professor Roger Williams identified 34 centres in England and Wales as offering specialist hepatology services, including 6 liver transplant centres. This March 2010 report is based on a follow up survey six years later. With other sources the survey will help to build a picture of hepatology services in 2010 and how they might be developed.

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