1) Consultant Outcomes Publication 2015
The ACPGBI will be presenting case numbers and risk-adjusted 90-day mortality for elective colorectal cancer surgery from the four-year audit period of April 2010 to March 2014. There was again an initial delay in release of HES data (required for risk adjustment) due to political concerns over data sharing and this was only made available in July 2015. The planned publication date on the ACPGBI website is 18 November 2015 and the same data will be made available on the MyNHS website a fortnight later. The final data sets were returned to all Trusts on 5 August 2015 with deadline of 28 August 2015 for corrections submitted via the Clinical Audit Platform. The final analysis has now been carried out. Outliers were notified on 21 September 2015 and the ACPGBI Pre-Publication Outlier Policy will be honoured. Re-analysis will only be carried out if this process results in alteration of the data set. Publication of outcomes at single surgeon level is a mandatory NHS England requirement and not subject to individual surgeon permission. The Audit has taken considerable effort in checking the accuracy of data by returning data to Trusts on three separate occasions over the past year to allow verification and correction of data.
2) Publication on ACPGBI website
The presentation will be similar to last year with surgeon outcome data presented within Trust groupings and using funnel plots for graphic presentation of both Trust and individual data. The URL will be the same as last year i.e. https://www.acpgbi.org.uk/surgeon-outcomes. All publication comments will be limited and presented under the Trust heading rather than next to individuals, e.g. about outlier status, Trust reservations about data accuracy, surgeons operating at more than one Trust, lack of data entry during 2013-14, etc. ACPGBI membership will again be acknowledged with names written in green and members labelled as “ACPGBI Surgeon”. We have commissioned links between names appearing in the COP pages and individual surgeon entries in the ACPGBI “A to Z”. Please use this opportunity to review and update personal entries on the ACPGBI website.
3) Clinical Audit Platform
Since 2014, data is uploaded to the Clinical Audit Platform (CAP), which allows real time checking of data and less need to clean the data. This has led to an increase in data quality and completeness. Consultant Outcomes Publication (COP) has also undoubtedly contributed to the increase in data quality and completeness within NBOCA. Access to the platform requires Single Sign On (SSO) available at https://clinicalaudit.hscic.gov.uk and approval of access by the Trust’s Caldicott Guardian emailed to firstname.lastname@example.org (HSCIC Contact Centre).
4) Standard Operating Procedure
The Audit team and ACPGBI Executive Lead have now established a standard operating procedure for COP which may be used as a template for future years. This has helped streamline the process this year and will hopefully facilitate taking on this role for future Executive Leads.
5) Publication Policies 2015
Surgeons will have their data published alongside the Trust where they were working on 31 March 2014. Where data has accumulated from more than one Trust, there will be a comment to this effect. If there are no cases registered against a surgeon’s GMC number for the two year period April 2012 to March 2014, the surgeon’s outcomes will not be published. If there are no cases registered against a surgeon’s GMC number for the one year period April 2013 to March 2014, the surgeon’s outcomes will be published on the ACPGBI website with a comment that no cases have been recorded for this period, but will not be submitted for publication to MyNHS. The definition for outlier for publication will be “alarm” level (lying outside three standard deviations i.e. the upper 99.8% limit for case volume). Individuals and Trusts falling in the “alert” category (95% to 99.8% upper limits for volume) will be notified to allow review of data and outcomes, but not published. We shall publish positive outliers at Trust level (there were none last year) but not at surgeon specific level.
6) Private Patients in COP
We have debated on how best to incorporate private patients within COP this year. Private practice is part of a Consultant’s overall practice, and so of importance to patients. We would support inclusion of private patients where data have been entered by a Trust’s data management team but are keen to avoid encouraging individual surgeons to enter their personal data. Private patients operated on in private hospitals will have limited risk adjustment as no HES data are available for them. There is no central funding for audit of private patients. NHS Trust Medical Directors only wish to see NHS and private patients operated on within their Trust in the overall data fed back to them by NBOCA. We believe the best current solution is to allow individual surgeon data to include all submitted private cases but Trust data should only include cases actually operated in that Trust whether as NHS or private patients. Where a surgeon’s data includes private cases done outside the Trust under which that surgeon is reported, the Audit shall keep a note of this and there will be a standardised form of words on our website publication to that effect. Mark Chapman, Chair of ACPGBI Independent Health Care Committee (IHCC) has supported this view as he feels that “our aim in the IHCC & ACPGBI should be to ensure all patients with cancer, out with the NHS, get at least the same level of treatment with MDT discussion, access to key worker/stoma care, patient information, data submission to NBOCA, etc .”
7) Data Review
Additional notice was given this year of potential alert and alarm status. Despite this, many affected Trusts only checked information uploaded on patients who died. Risk adjustment uses case mix and so it is important that whole data sets are checked, including clinical information relating to survivors. There are still some Trusts and individuals who do not engage with the data validation and correction processes until they receive the final analyses just prior to COP. The Audit is constantly trying to promote awareness and engagement at the early stages, and the ACPGBI will help with dissemination of review deadlines each year.
8) MyNHS publication
Consultant outcomes will again be published this year on the MyNHS website. The ACPGBI worked closely with NHS England last year to ensure that the publication in this format could not lead to a league table style of presentation. We continue to have reservations about the poor and misleading presentation of data on MyNHS when far better patient information, context and funnel plots are available on our website. In view of this, we have again commissioned Mixd (our website manager) to create a direct web link for every surgeon included in COP which will be placed alongside the entry on MyNHS. Using the link will take any user directly to the relevant page on our website and so provide immediate contextual information.
There is continued concern about the lack of indemnity to cover the COP process. HQIP have confirmed that there is indemnity to £50 000 to cover the audit data collection and analysis process, but this does not cover publication, which is the role of ACPGBI. The RCS (Eng) has confirmed that it will not take out an “umbrella” indemnity policy for all the surgical audits published. The former ACPGBI Treasurer Peter Dawson arranged indemnity last year to cover publication and a similar policy will be taken out this year with an increased level of cover.
An ACPGBI press release will be prepared in anticipation of 2015 COP and released by the RCS Press Office who will also handle press enquiries. Mark Coleman, Chair of External Affairs, will advise on press and social media engagement for COP.
11) Post Publication Outlier Policy
Under the guidance of Paul Rooney, Chair of the ACPGBI Clinical Governance Board, the Members of the Board have made recommendations on how outlying surgeons and Trusts should be managed.
12) Future of COP
The ACPGBI has continued to promote the concept of publication of data at Trust level. It has been made clear that at least one additional data item will be required each year for the next five years of COP. The Clinical Advisory Group and Audit team remain concerned that publishing isolated outcomes will be detrimental to good clinical practice but remains cognisant of the need to provide patients with robust and useful information.
13) Consultant Outcome Publication 2016
The initial deadline for 2014-15 COP data is 5 October 2015. Trusts will receive feedback on the initial data extract on 19 October 2015 and have until 21 November 2015 to update changes through the Clinical Audit Platform. The Audit will feed back on the second extraction of data on 23 November 2015. The final data submission deadline is 7 December 2015. Any new patient added after this stage will not be linked to HES and death data and will not be included in COP 2016. In other words, now is the ideal time to update data sets in preparation for COP 2016.
14) Succession Planning for ACPGBI Executive Lead for COP
It is anticipated that the role of ACPGBI Executive Lead for COP should in future become the responsibility of the Honorary Assistant Secretary who is currently responsible for membership affairs. This change will come with the appointment of the next post-holder in July 2016 and be reflected in the job description for that role.
ACPGBI Executive Lead for COP