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The Royal College of Radiologists

The Royal College of Radiologists. Leading, Supporting and Educating 2014 Membership survey. You spoke – we listened. 1653 Fellows and members gave their views feedback on RCR leadership, education and support Council considered all comments. Survey findings:.

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The Royal College of Radiologists

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  1. The Royal College of Radiologists Leading, Supporting and Educating 2014 Membership survey

  2. You spoke – we listened 1653 Fellows and members gave their views feedback on RCR leadership, education and support Council considered all comments

  3. Survey findings: You thought we should . . . provide greater support to Fellows and members across their careers be perceived as less Anglo and London-centric be more active in political discourse with a higher media profile promote the professionalism of oncologists and radiologists raise public awareness of our specialties promote the development of interventional radiology enhance member engagement and deliver better value for money provide improved online education resources better support those overseas and raise our international standing do more to encourage and support research improve doctors in training engagement

  4. What we have done: posted a report of survey findings on the website included survey themes in the new College strategy for 2014-16 begun regular updates of Fellows and members (“What you said . . What we’re doing”) fed messages/ideas into a review of College communications

  5. What we will do: continue to update all Fellows and members use survey feedback to inform the redesign of the website update on progress at the AGM offer "meet the Officers" opportunities at the ASM seek more specific feedback from Fellows and members on areas of activity/initiatives repeat the membership survey in approx. two years’ time

  6. How can commissioners assure the quality of radiological services? Dr Pete Cavanagh, RCR Vice-President, Clinical Radiology

  7. Overview • Commissioning framework • What is quality in radiology • Potential tools/levers for ensuring quality

  8. Commissioning Framework New NHS Architecture Parliament DOH NHS Commissioning Board Monitor CQC Local Authorities Clinical Commissioning Groups Providers Local Health Watch Patients and Public

  9. Sounds simple for a CCG….? Trauma 100s of single provider contracts or individual patient placements <£100k Deprivation Dementia Cataracts Weight management A&E Cancer 1-3 large acute contracts, value >£50million 10 - 30 smaller inpatient and community contracts c. £1million General surgery Depression Maternity Neurology Disadvantaged groups Rehab Respiratory Comorbidities Long Term conditions

  10. NHS Outcomes Framework Five domains • Preventing people from dying prematurely • Enhancing quality of life for people with long-term conditions • Helping people to recover from episodes of ill health or following injury • Ensuring that people have a positive experience of care • Treating and caring for people in a safe environment and protecting them from avoidable harm and doing this in the most efficient, cost-effective way

  11. Specialised Commissioning • Specialised services, a few specialist centres, popn >1m • Rare conditions previously commissioned at national & regional level • Directly commissioned by NHS England • The Specialised Services National Definitions Set (SSNDS) covers relevant conditions & treatments • Supported by CRGs

  12. What is quality in radiology • Patient Outcomes • Patient Experience • Patient safety • Access/timeliness • Equity • Efficiency

  13. Tools and levers for ensuring quality in radiology • Contracting • specifications • monitoring • Accreditation Schemes • Inspections/Reviews • Standards • Benchmarking

  14. Monitoring Quality Assurance • The proposed Quality Assurance process should include, • Ongoing 5% audit to include the technical quality of the examination and the structure and content of clinical report – mechanism to be agreed with Commissioner • Annual assurance of competency and up to date continuous professional development • Participation by all staff in ‘errors meetings’ or similar clinical governance processes. • The recall rates for Patients (annual report) and the reasons. • Monthly image reject analysis (including breakdown of the reason and at what stage the rejection occurred.

  15. Accreditation The Imaging Services Accreditation Scheme (ISAS)

  16. Overview • A patient-focussed accreditation scheme • Designed to improve imaging services by promoting: • a professionally relevant developmental model • improved service efficiencies • continuous quality improvement • Accreditation against a standard jointly owned by RCR & College of Radiographers (SCoR) • Delivered & run by United Kingdom Accreditation Service (UKAS)

  17. ISAS standard • The Standard has 4 domains • Clinical (CL) • Facilities, resources and workforce (FR) • Patient experience (PE) • Safety (SA) • Domains • have an explanatory commentary • a series of standard statements • CL has 9 statements • FR has 8 statements • PE has 5 statements • SA has 9 statements

  18. ISAS • Support available • RCR and SCoR ISAS officer • Traffic light ready self-assessment tools • UKAS preparation for accreditation workshops • Further information: www.isas-uk.org • Interest in ISAS • Currently 15 accredited depts. in UK • 24 depts. actively engaging with UKAS • A further 25 depts. giving consideration • Potential for implementation in Wales & Northern Ireland • Working to ensure that ISAS can inform CQC inspections

  19. Inspections/Reviews • CQC • RCR

  20. CQC What they inspect What they look at Is the service Safe Effective Caring Responsive to needs Well led • A&E • Medicine • Surgery • Intensive/critical care • Maternity • Childrens care • End of Life • Outpatients

  21. Standards/Guidelines • NHS England • NICE • No specific radiology service standard • Pathways involve imaging • RCR

  22. Clinical Standards for 7day careDiagnostics, standard 5 Hospital inpatients must have scheduled 7-day access to diagnostic services such as x-ray, US, CT, MRI, echocardiography, endoscopy, bronchoscopy and pathology. Consultant-directed diagnostic tests and completed reporting will be available seven days a week: • Within 1 hour for critical patients • Within 12 hours for urgent patients • Within 24 hours for non-urgent patients

  23. DH involvement with Interventional Radiology • Interventional Radiology (IR): ‘Improving Quality and Outcomes for Patients’ (DH, National Imaging Board 2009) • Interventional Radiology: Guidance for Service Delivery (DH 2010) • Delivering the Service:Interventional Radiology for Major Trauma Networks (DH 2010) • Towards best practice in IR – (NHS Improvement 2012)

  24. Interventional Radiology ‘Never Events’ • The following are scenarios where hospital trusts should have clearly defined pathways for patients to access IR 24/7: • Trusts should have clear pathways to access IR in order to prevent women dying or undergoing emergency hysterectomy for post partum haemorrhage • No patient should undergo laparotomy for lower GI bleeding from any cause without a referral to interventional radiology for possible embolisation • No patient should undergo surgery for upper GI bleeding without first undergoing endoscopic treatment and interventional radiology if this fails or is not appropriate • No patient with sepsis secondary to obstructed kidneys should wait longer than 4 hours for nephrostomy • No patient with symptomatic fibroids should undergo hysterectomy without being informed about all possible options including Uterine Artery Embolisation • Add IR never events

  25. RCR Standards & Guidelines

  26. RCR Standards & Guidelines

  27. College Guidelines: RCR (2009):Standards for providing a 24-hour radiology service Acute intervention including damage control surgery, . . . . . . . . . interventional radiology, haemorrhage control, and blood transfusion. Interventional suites should be co-located with operating rooms &/or resuscitation areas. Interventional radiology (IR) taking place within an MTC should be available 24 hours a day. Patients requiring acute intervention for haemorrhage control should be in a definitive management area (operating room or IR suite) within 60 mins of arrival.

  28. Audit/Benchmarking • Audit • National • Local • Benchmarking • DID • UK Benchmarking • Atlas of variation

  29. RCR Audit of appropriate GP Referal for CT/MRI imaging • Imaging referral guidance available in only 2/3 UK radiology depts.- low but addressed by N3 distribution • Meticulous vetting / justification of 95-96% of exams requested by GPs- within standard of 95% • Appropriateness of imaging in 92-93% of exams requested by GPs- within standard of 90% Awareness, appropriateness and audit

  30. Benchmarking • Diagnostic Imaging Dataset • Atlas of Variation • NHS Benchmarking

  31. The Diagnostic Imaging Dataset: DID • Monthly • Direct from RIS • Every imaging event: requester, demographics, code of test etc • Report turnaround & waiting times • Link to outcomes via HES & Cancer registries • Extending to include all diagnostics Aim: to establish optimum intervention rates

  32. What can we view? • Measure • Count • Rate per 1000 GP registered population • GP Practice population • Test request to test • Test to report issued • Type • Commissioner • Provider • CCG

  33. Referral source breakdown (based on Imaging count) - All

  34. DID: Ultrasound usage by CCG

  35. GP Practice within CCG chart rate per 1000 register population

  36. The NHS Atlas of Variation Looking at rate of healthcare interventions undertaken per population

  37. Rate of magnetic resonance imaging (MRI) activity per weighted population by PCT, 4 fold variation2010/11

  38. Rate of PET/CT activity per population, by PCT, 25 fold variation2010/11

  39. NHS Improvement Survey 2011, MTCs Red: No core service provision and no network pathways - includes adhoc rotas. Amber: Some core services available on a formal rota, limited formal network provision Green: Core service provision or partial service provision with a formal rota and formal network pathways to an agreed recipient trust. White : No data received

  40. 2011 Survey 2012 Survey

  41. 2011 Survey 2012 Survey

  42. UK Benchmarking • Who are they • one of the world’s largest healthcare benchmarking groups involving Health and Social Care organisations throughout the UK. • What they do • Raising standards through sharing excellence

  43. Radiology benchmarking • Conceived by members • Reference group established from members • Scoping session Dec 2011 • 1st report – May 2012 • 2nd report – November 2012 • Validation throughout • 65 NHS Trust participants

  44. Access to Radiology servicesStandard response times Waiting times for routine inpatients are 7 days or less in all participants. The median position is 1 day. Outpatient waiting times are 6 weeks or less in all but one Trust. The median wait is 4 weeks which demonstrates pressure on 6-week waiting time targets.

  45. Report turnaround timesAverage turnaround

  46. Overview • Commissioning framework • What is quality in radiology • Potential tools/levers for ensuring quality

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