More weekend services and early specialist triage can help manage demand and improve productivity, says GIRFT
A range of measures to help the NHS recover gastroenterology services and mitigate against surges of COVID-19 are outlined in the latest national report from the Getting It Right First Time (GIRFT) programme, which can be downloaded here.
Hospital gastroenterology teams care for millions of patients every year – gastrointestinal (GI) complaints account for one in ten GP consultations and digestive diseases are a factor in one in eight deaths.
The new national report offers practical solutions for managing the demand for services and optimising the capacity of units in England, with a particular focus on meeting challenges created by the COVID-19 pandemic, such as the backlog of patients waiting for endoscopic procedures and gastroenterology clinic appointments.
Written by Dr Beverly Oates, GIRFT’s clinical lead for gastroenterology and a consultant physician and gastroenterologist at Wirral University Teaching Hospital (WUTH) NHS Foundation Trust,as well as BSG Treasurer, the report’s recommendations aim to ensure the right patients are prioritised and then cared for quickly, efficiently, and safely.
Aligning with Professor Sir Mike Richards’ recent review of diagnostic services Diagnostics: Recovery and Renewal – commissioned by NHS England and NHS Improvement – measures in the report include:
More six- and seven-day services and extended hours, to boost capacity and improve patient flow
Gastroenterology has expanded at a greater rate than any other acute major medical specialty over the past 30 years, due in part to increased demand for diagnostic and therapeutic endoscopy. Before the pandemic, 71% of trusts had six- or seven-day endoscopy lists and 54% of trusts were doing weekend gastroenterology ward rounds, but more weekend and evening services are needed to meet demand, with additional recruitment to ensure staff do not burn out. Extra sessions will mean that patients can be seen more quickly and return home with minimal hospital exposure to COVID-19.
Better triage to help streamline referrals
Early specialist triage will ensure the most urgent patients are seen first and identify those who no longer need to attend hospital, which will reduce waiting times for those that do. The report also recommends closer working with primary care colleagues to improve awareness of services which allow patients to better self-manage their condition.
Dr Oates said: “Given the significant pressures on capacity, now exacerbated by COVID-19, it is essential we have early specialist triage of referrals for gastroenterology opinions and endoscopy procedures to appropriately prioritise patients, ensure correct care first time, and avoid unnecessary appointments and procedures. This will help us increase productivity at the same time as putting the safety of our patients and the quality of our healthcare provision first.”
More proactive care programmes for patients with chronic conditions
Liver disease is the biggest cause of death in those aged between 35 and 49 and the third leading cause of premature death. Proactive programmes, giving patients access to services such as community alcohol care teams or weight loss clinics, will help patients better manage their own condition, minimising the need to be seen in hospital and reducing emergency admissions for cirrhosis.
Similarly, more proactive management for patients with inflammatory bowel disease (IBD) will help enable earlier diagnosis and management of flare-ups, reduce emergency admissions and the need for surgery.
The in-depth GIRFT report is based on visits to all 129 NHS trusts in England providing gastroenterology services, and features more than 20 examples of best practice seen by the team during their 18-month review. The recommendations also present the opportunity for potential cost efficiencies of between £35m and £62m a year.
Dr Oates said: “It has been sobering to witness first-hand the immense pressures we are all feeling on our time and our resources, especially during the COVID-19 pandemic, but also inspiring to see so many innovative solutions, and to share those learnings in the hope of achieving better outcomes for patients and providers alike.
“We are facing unprecedented times in terms of the demand for our specialty, combined with long-term capacity and consultant recruitment issues. However, throughout our visits we saw many reasons to be inspired and hopeful for the future, and many achievements to celebrate.”
The report is endorsed by the British Society of Gastroenterology. President Dr Alastair McKinlay said: “The recommendations in this report could not be more timely, as services across the country restore elective activity severely disrupted by the COVID-19 pandemic. As the report clearly sets out, clinicians and managers working in gastroenterology services should seek to prioritise and streamline specialty work, while ensuring that patients are triaged appropriately to minimise any delay to their care.”
The charity group Guts UK has also supported the report. Chair Professor Jonathan Rhodes said: “Guts UK strongly supports the GIRFT report for gastroenterology – its implementation should greatly enhance the quality of care for patients with disorders of the gut, liver and pancreas.”
Download the full Gastroenterology report here.