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, the report’s recommendations aim to ensure the right patients are prioritised and then cared for quickly, efficiently and safely.
The 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. Measures in the report include:
More proactive care programmes for patients with chronic conditions: Proactive management for patients with IBD will help enable earlier diagnosis and better management of flare-ups, as well as reducing emergency admissions and the need for surgery. Proactive IBD services may include prioritisation of suspected IBD referrals, better access to IBD specialist nurse helplines and flare clinics, which can help patients to deal with flare-ups at home or with GP support.
Similarly, the report suggests proactive programmes to help patients with liver disease - the biggest cause of death in those aged between 35 and 49 and the third leading cause of premature death. 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.
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.
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.
Dr Oates
The report can be accessed on the FutureNHS platform here: GIRFT national report for gastroenterology.
