Agenda item

The Committee received a report of the Director of Transformation and Partnerships  that provided an update in respect of a clinical audit undertaken in respect  of North Durham Clinical Commissioning Group’s Rapid Specialist Opinion (RSO) service (for copy see file of Minutes). The Chairman advised members that notification of consideration of this item had been passed to Roberta Blackman-Woods M.P.

Mike Brierley, Director of Corporate Programmes, Delivery and Operations, North Durham CCG shared the findings of the clinical audit undertaken of the RSO process.  Members were advised that the aim of the service was to provide the most appropriate treatment for a patient’s condition and only affected the following services:- dermatology, ophthalmology, ENT, gastroenterology, cardiology, gynaecology.  Members were advised that Dr John Nicholls had carried out the referral of audits working with seven practices, covering all three localities.  There had been a regional procurement exercise carried out and interest shown from GP federations. Option 2 was preferred which would see the RSO continue for a further year.

Referring to table 6 of the report, Councillor Temple asked what the elective admissions were and was advised that they were planned admissions booked in.  Councillor Temple was concerned about the effect on the long term system and the admission of failure to train referrers.  He added that if unnecessary referrals were removed the result would be the same as the amount of elective referrals.  Mr Brierley explained that people on waiting lists could be pulled down but that it was the hardest part to quantify.  Councillor Temple went on to add that he was concerned at the lack of analysis of elective admissions versus the people put through.  He asked if people removed from the system were adversely affected.  Mr Brierley advised that the way of managing referrals did have a shelf life and the audit of the cross section of people referred back.  If an RSO was not in place it was harder to quantify.  Councillor Temple referred to the part of the report where it stated that there was no clinical disadvantage however he believed that the clinical audit represented half the number and did not feel that the report explained why the numbers were so different.  Mr Brierley explained that it reflected the difference in undertaking the audit.  He added that primary care was done as a matter of course.  The RSO number of referrals was not done as a matter of routine.  He said that it was difficult to undertake an audit in primary care.  Councillor Temple believed that the report justified the actions rather than analysis. Mr Brierley commented that the report sought to understand the impact of an RSO and the impact of deliverability, to manage demands and re-invest back into primary care.

The Chairman agreed with Councillor Temple in that there was no evidence base and that the report did not give any assurances.  Mr Brierley would speak to Dr Nicholls about providing more information.

Councillor Davinson agreed that further robust evidence was required.

Mr Chandy, DDES CCG explained that GPs could not use RSO if they felt that it would compromise the safety of a patient.  If patients were wrongly denied treatment through an RSO then the practice would not sign up for it.  He explained that not every referral result was an inpatient procedure and it was about balancing demand and supporting clinicians.

In noting the reduction in unnecessary referrals and the cost savings associated with this, the Committee felt that they would have expected to see more information within the audit report detailing how alternative treatment pathways had benefitted patients. It was suggested that further information be brought back to the Committee in 12 months time.

Resolved:

That the report be received and a further report be brought back to the Committee in 12 months time.