Recently published article in the BMJ highlights the challenges we are facing in delivering endoscopy services in the UK. Abstract below:
Introduction: The 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.
Methods: All 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.
Results: A 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.
Conclusion: This 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.
What is already known on this topic
•The demand for gastrointestinal endoscopy has increased greatly for both symptomatic patients and bowel cancer screening; overall demand has doubled in many UK centres over the last 5 years.
•This has inevitably placed a greater pressure to meet national waiting time requirements.
What this study adds
•This survey of all 508 Joint Advisory Group on Gastrointestinal Endoscopy registered endoscopy units demonstrates these pressures and shows the actions they are taking.
•Many services are not meeting national waiting time targets. For example, 20% Acute National Health Service (NHS) units in England, 64% units in Northern Ireland, 40% units in Scotland and 42% in Wales failed to meet urgent suspected cancer targets.
•Shortages of endoscopists and nursing staff were cited as the biggest barrier that prevents units meeting the demand. Services have introduced extended working hours during the week and at weekends to increase capacity; 66% of acute NHS units do lists most or every weekend.
•Many NHS services are paying for ‘insourcing’ in their unit as well as ‘outsourcing’ patients to other services; both are used by approximately 25% of acute English units.