Joint Advisory Group on GI Endoscopy 2015 GRS … Policies and Reports... · 2015 GRS Census – Analysis of Responses . 2 The Strategy Unit Midlands and Lancashire CSU Background

05/04/2016

Joint Advisory Group on GI Endoscopy

2015 GRS Census – Analysis of Responses

2

The Strategy Unit Midlands and Lancashire CSU www.midlandsandlancashirecsu.nhs.uk

Background

Annual Census of Endoscopy Units

Conducted during April and May 2015

477 units invited to participate.

Note : An organisation may have many units.

Four Parts

1 Unit Profile and Capacity

2 GRS Timeliness

3 Activity within Endoscopy Unit

4 Workforce Delivering the endoscopy Service

Plus weblink to additional survey containing

CRUK research questions.

3


Response Rates 79% of units completed the census. Higher response rate amongst England Acute Trusts (89%).

Completed

Signed-Off

Pending

Sign-Off

Partial

Response

No

Response Total

England – acute n 189 6 12 14 221

% (86%) (3%) (5%) (6%)

England – community n 25 1 1 22 49

% (51%) (2%) (2%) (45%)

England - independent sector n 99 6 3 10 118

% (84%) (5%) (3%) (8%)

Northern Ireland n 13 1 1 2 17

% (76%) (6%) (6%) (12%)

Scotland n 23 1 11 17 52

% (44%) (2%) (21%) (33%)

Wales n 15 1 4 0 20

% (75%) (5%) (20%) (0%)

Total n 364 16 32 65 477

% (76%) (3%) (7%) (14%)

All remaining slides relate only to responses

from England Acute Trust Units.

4


Response Rates by Survey Section Above 90% for each survey section.

Completed Partial No Response Unknown Total

Part 1 - Unit Profile n 203 4 14 0 221

% (92%) (2%) (6%) (0%)

Part 2 - GRS Timeliness n 203 3 14 1 221

% (92%) (1%) (6%) (0%)

Part 3 - Activity n 201 5 14 1 221

% (91%) (2%) (6%) (0%)

Part 4 - Workforce n 200 6 14 1 221

% (90%) (3%) (6%) (0%)

Of 221 England Acute Trust Sites

5


Procedure Rooms 658 procedure rooms in total. Mean 3.24 rooms per unit.

16.7% of units use or lease rooms off-site.

15

52

67

38

13 11

4 0

3

1 2 3 4 5 6 7 8 9

Fre

que

ncy

Number of Procedure Rooms

Number of Procedure Rooms per Unit

Of 203 responding England Acute Trust Units

6


Staffed GI Sessions 5,800 staffed sessions per week. Mean 28.6 staffed sessions per unit per week.

12 15

21

47

24

35

12 13

5 7

1 2 2 2

5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

Fre

que

ncy

GI Sessions per Week

Number of Staffed GI Sessions per Week


7


Scheduled GI Sessions 5,684 scheduled sessions per week. Mean 28 scheduled sessions per unit per week.

Ratio of scheduled to staffed sessions, 0.98.

13 15

28

39

30

27

18

10

5 3

5 4 4

1

5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

Fre

que

ncy

GI Sessions per Week

Number of Scheduled GI Sessions per Week


8


Dedicated Training Lists 1,009 dedicated training lists per week. Mean 5.0 lists per unit per week.

66

74

34

10 8

6 4

0 0 0 1

0-2 3-5 6-8 9-11 12-14 15-17 18-20 21-23 24-26 27-29 30-32

Fre

que

ncy

Training Lists per Week

Number of Dedicated Training Lists per Week


9


Training Lists as a Proportion of Staffed GI Sessions. 17% of staffed GI sessions are training lists.

19

36

49

31

25

19

9

2

7

1 3

1 1

0% -5%

5% -10%

10% -15%

15% -20%

20% -25%

25% -30%

30% -35%

35% -40%

40% -45%

45% -50%

50% -55%

55% -60%

60% -65%

Fre

que

ncy

Training Lists / Staffed Sessions

Training Lists as a Proportion of Staffed Sessions


10


GRS Timeliness Score Self assessment against JAG criteria (see appendix). 63% of units achieve highest standard,

substantially lower than in 2014 (78%).

A, 128, 63%

B, 38, 19%

C, 24, 12%

D, 13, 6%

Timeliness Score by Site


11


Waiting List Initiatives In 2014, 37% of units held regular weekend sessions, 73% held ad-hoc weekend sessions

and 20% held evening sessions.

Yes, 76,

37%

No, 127, 63%

Regular scheduled

weekend work

at enhanced rates of pay

Yes, 148, 73%

No, 55,

27%

Ad-hoc weekend work


Yes, 40,

20%

No, 163, 80%

Evening sessions



12


Outsourcing Activity to Other Providers 22% of units outsource activity to other providers in 2014.

No outsourcing, 158, 78%

Outsourced - Provider Accredited,

22, 11%

Outsourced - Provider working

towards accreditation, 15, 7%

Outsourced - Provider not working

towards accreditation, 8, 4%

Outsourced activity to external provider


13


Commissioning External Staff to Use a Unit’s Facilities 10% of Units commission complete external teams to add capacity within the unit’s facilities.

23% of units commission external endoscopists to add capacity using the unit’s facilities and

nursing teams.

Yes, 21, 10%

No, 182, 90%

External Provider Team

using Own Facilities

Yes, 46, 23%

No, 157, 77%

External Endoscopists

using Own Facilities and

Nurses


14


Difficulty Meeting Demand 65% of units score 8+ in response to question about difficulty meeting demand in 2014.

2 4 4

6

18 15

23

59

22

50

1 2 3 4 5 6 7 8 9 10

Fre

que

ncy

Likert Scale (1-10)

On a Scale of 1 -10, please indicate how difficult it has been during 2014 to

deliver sufficient capacity to meet demand for endoscopy?


15


DNA Rates – Standard Activity Mean DNA rate, 4.6%.

9

14

28 27

32

23 23

20

11

7 9

0% - 1% 1% - 2% 2% - 3% 3% - 4% 4% - 5% 5% - 6% 6% - 7% 7% - 8% 8% - 9% 9% -10%

10% +

Fre

que

ncy

DNA Rate

DNA Rates - Standard


16


DNA Rates – BCSP Activity DNA rates for BCSP activity much lower than for standard activity. Mean DNA rate, 0.3%.

172

16 8

1 1 4 1 0 0 0 0

0% - 1% 1% - 2% 2% - 3% 3% - 4% 4% - 5% 5% - 6% 6% - 7% 7% - 8% 8% - 9% 9% -10%

10% +

Fre

que

ncy

DNA Rate

DNA Rates - BCSP


17


Activity Levels Responding Units reported conducting c. 1.6m endoscopies in 2014. Approx. 5% of this activity was carried out as part of the Bowel Cancer Screening Programme.

254,935

468,844

8,174

730,537

47,429

13,184

566

22,520

53,124

Flexible sigmoidoscopy

Colonoscopy

EUS Upper GI

Upper GI

ERCP

EUS HPB

Lo

we

r G

IU

pp

er

GI

HP

BO

the

r

GI Endoscopy Activity in 2014 by Procedure Type


18


Endoscopists 3,332 endoscopists conduct 5,437 sessions per week. Mean 1.6 session per endoscopist

per week. Consultant gastroenterologists conduct the most sessions. Nurse endoscopists

conduct the most sessions per member of staff.

803

1231

362

204

433

211

30

58

Consultant ColorectalSurgeons

ConsultantGastroenterologists

Consultant Upper GI orHPB Surgeon

Non-cons medicalendoscopists

Nurse endoscopists

Other Consultants (eg.radiologist)

Other non-medicalendoscopists

Primary careendoscopists

Number of Staff

842

2,475

329

397

1,024

240

61

69

Number of Sessions per week

1.0

2.0

0.9

1.9

2.4

1.1

2.0

1.2

Sessions per Staff per week


19


Trainees 1,077 trainees. Similar number of gastroenterology and surgical SpRs. On average 69% of

a trainee’s lists are training lists.

478

117

40

442

GastroenterologySpR trainees

Non-medical trainees

Other medicaltrainees (eg.

radiology)

Surgical SpRtrainees

Number of Trainees

219

74

120

499

147

296

Service / Training Lists per week

Service Lists

Training Lists


0.5

0.6

0.6

0.3

1.0

1.3

1.1

0.7

Sessions per Staff per week

20


Nurse and A&C Staff 5,797 WTE nurses and 1,241 WTE A&C staff in establishment. Vacancy rates vary from 4.9% to

12.3% by staff type and grade. Vacancy rate notably high in band 5 nurses, the largest staff group.

917

620

168

3,174

588

256

74

501

466

191

64

20

2

3

4

5

6

7

8

2

3

4

5

6

Nu

rse

sA

&C

Nursing and A&C Staff Establishment 10.8%

10.9%

6.5%

11.9%

7.5%

7.2%

5.4%

9.7%

8.3%

4.9%

8.3%

12.3%

Vacancy Rate


21


Key Findings

Approximately 90% of NHS acute trust

endoscopy units in England completed the

census.

These providers reported :

• 658 procedure rooms

• 5,800 staffed and 5,684 scheduled GI sessions

per week, including 1,009 dedicated training

lists

• 3,332 endoscopists, 1.077 trainees, 5175

(WTE) nurses and 1,137 A&C staff in post.

• c. 1.6m endoscopic procedures of the GI tract

in 2014 or which c. 5% was for BCSP.

There were reductions in self-reported

timeliness and a substantial proportion of

providers reported difficulties meeting demand.

Many providers reported the use of initiatives to

increase activity, most commonly ad-hoc

weekend sessions.

A significant minority of units reported

outsourcing activity or using external staff within

their facilities to boost activity levels.

Reported DNA rates were significantly higher for

standard than screening activity. DNA rates

varied significantly between units.

22


Contact

For questions about the survey, please contact:

Raphael Broughton

Accreditation e-systems manager and analyst

Care Quality Improvement Department

Royal College of Physicians

11 St Andrews Place | London NW1 4LE

Tel:+44 (0)20 3075 1372

Email: [email protected]

For questions about this analysis, please contact:

Steven Wyatt

Head of Strategic Analytics

The Strategy Unit

NHS Midlands and Lancashire CSU

438-450 High Street | Kingston House | B70 9LD

Tel: 0121 612 3872

Email: [email protected]

mailto:[email protected]

mailto:[email protected]

23


Appendix – GRS Timeliness criteria

8.1 The hospital waiting list policy is available in the unit D

8.2 The endoscopy operational policy includes all referral,

booking and scheduling rules

D

8.3 The endoscopy unit has a waiting list management system

that records new and recall (planned/surveillance) patients

D

8.4 There is a named person responsible for the waiting list. D

8.5 Waits are < 4 weeks for urgent colonoscopies and <8 weeks

for other urgent endoscopy procedures and/or <52 weeks for

routines

D

8.6 Waits for recall (surveillance) procedures are <52 weeks

beyond the planned date

D

8.7 Waits are <4 weeks for all urgent endoscopy procedures and

<26 weeks for routines

C

8.8 Waits for recall (surveillance) procedures are <26 weeks

beyond the planned date

C

8.9 Endoscopy waiting list information is communicated to the Endoscopy team

at least monthly

C

8.10 There is some pooling of endoscopy lists C

8.11 Waits are <2 weeks for urgent endoscopy procedures and <13 weeks for

routines

B

8.12 Waits for recall (surveillance) procedures are <13 weeks beyond the planned

date

B

8.13 There is regular administrative validation of waiting lists B

8.14 Waits are <2 weeks for urgent procedures and <6 weeks for routines A

8.15 Waits for recall (surveillance) procedures are <6 weeks beyond the planned

date

A

8.16 Capacity can be flexed according to demand to ensure waits are within the

above limits

A

All criteria from a grade must be met in order to attain that grade, otherwise the lowest grade with fully met criteria is selected

Documents

Joint Advisory Group on GI Endoscopy 2015 GRS … Policies and Reports... · 2015 GRS Census – Analysis of Responses . 2 The Strategy Unit Midlands and Lancashire CSU Background