IntroductionThe Joint Advisory Group on Gastrointestinal Endoscopy (JAG), hosted by the Royal College of Physicians, London, oversees the quality assurance of endoscopy services across the UK. Additional questions focusing on the pressures faced by endoscopy units to meet targets were added to the 2017 annual Global Rating Scale (GRS) return. This provides a unique insight into endoscopy services across all nations of the UK involving the acute and non-acute Nation Health Service sector as well as the independent sector.MethodsAll 508 services who are registered with JAG were asked to complete every field of the survey online in order to submit their completed April 2017 GRS return.ResultsA number of services reported difficulty in meeting national waiting time targets with a national average of only 55% of units meeting urgent cancer wait targets. Many services were insourcing or outsourcing patients to external providers to improve waiting times. Services are striving hard to increase capacity by backfilling lists and working weekends. Data collection was done in most units to reflect productivity but not to look at demand and capacity. Some of the units did not have an agreed capacity plan. The Did Not Attend rates for patients in the bowel cancer screening programme were much lower compared with standard lists.ConclusionThis review highlights the increased pressure endoscopy services are under and the ‘just about coping’ situation. This is the first published overview of different aspects of UK-wide endoscopy services and the future challenges.
IntroductionThe 2017 Joint Advisory Group on Gastrointestinal (GI) Endoscopy (JAG) census highlighted the pressure endoscopy services were under in meeting national targets and the factors behind this. In 2019, JAG conducted a further national census of endoscopy services to understand trends in activity, workforce and waiting time targets.MethodsIn April 2019, the census was sent to all eligible JAG-registered services. Collated data were analysed through various statistical methods. A further comparative dataset was created using available submissions from the 2017 census matched to services in the current census.ResultsThere was a 68% response rate (322/471). There has been a 12%–15% increase in activity across all GI procedures with largest increases in bowel cancer screening. Fewer services are meeting waiting time targets compared with 2017, with endoscopist, nursing and physical capacity cited as the main reasons. Services are striving to improve capacity: 80% of services have an agreed business plan to meet capacity and the number using insourcing has increased from 13% to 20%. The workforce has increased, with endoscopist numbers increasing by 15%, nurses and allied health professionals by 14% and clerical staff by 30%.ConclusionsThe 2019 JAG census is the most recent and extensive survey of UK endoscopy services. There is a clear trend of increasing activity with fewer services able to meet national waiting time targets than 2 years ago. Services have increased their workforce and improved planning to stem the tide but there remains a continued pressure to deliver high quality, safe endoscopy. In light of the COVID-19 pandemic, JAG recognises that these pressures will be severely exacerbated and waiting time targets for accreditation will need adjustment and tolerance during the evolution and recovery from the pandemic.
Introduction: The endoscopy Global Rating Scale (GRS) is a web based self-assessment quality improvement tool providing a framework for service improvement. Widespread use of the GRS in adult endoscopy services in the United Kingdom (UK), has led to a demonstrable improvement in quality. The adult GRS is not directly applicable to paediatric endoscopy services. Objectives: To develop and pilot a paediatric endoscopy GRS (P-GRS) as a quality improvement tool. Methods: Members of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Endoscopy Working Group collaborated with the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) to develop the P-GRS. After a period of consultation this was piloted nationally in 9 centres and data was collected prospectively at two census points, May and December 2016. Results: The P-GRS mirrors the adult GRS by dividing care into four domains and includes 19 standards with several measures that underpin the standards. Eight services completed the online P-GRS return in May 2016 and six in December 2016. All pilot sites identified areas that needed improvement and post-pilot reflected on the key challenges and developments. Several positive developments were reported by the pilot sites. Conclusions: The national pilot helped ensure that the P-GRS developed was relevant to paediatric endoscopy services. The pilot demonstrated that even in the first year of engaging with this quality improvement tool, services were starting to identify areas that needed improvement, share best practice documents, put in place quality improvement plans and support greater patient involvement in services.
-Accreditation is one method of assuring quality. Accreditation requires the setting of standards and the creation of a robust and reliable process for assessing them. Accreditation offers different advantages to different groups, eg quality assurance to commissioners and the boards of provider organisations, confidence and choice for patients, and a quality improvement pathway for services to follow. This paper is focused on service accreditation and it proposes that service accreditation be professionally led.
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