A Soni-Jaiswal1, C Philpott2,3, C Hopkins4,5. 1. Lancashire Teaching Hospitals NHS Trust, Preston, UK. 2. James Paget University Hospital, Great Yarmouth, UK. 3. Norwich Medical School, University of East Anglia, Norwich, UK. 4. Guys and St Thomas' Hospital, London, UK. 5. King's College, London, UK.
Abstract
OBJECTIVES: To assess the compliance of clinical commissioning groups (CCGs) in England with the ENT-UK rhinosinusitis commissioning guide produced in collaboration with the Royal College of Surgeons England and the National Institute of Clinical Excellence. We also aimed to assess the ease of accessibility of data from CCGs. DESIGN: Audit of compliance of English CCGs with the ENT-UK rhinosinusitis commissioning guide. SETTING: CCGs in England PARTICIPANTS: A total of 58 of the 221 CCGs in England were included and chosen because they were the first CCGs authorised by NHS England, or alternately, the CCGs forecasted to have a deficit in their first year of operation. Their websites were reviewed; when information was not easily accessible, a freedom of information request was submitted to the relevant CCG. MAIN OUTCOME MEASURES: Compliance with commissioning guidelines for rhinosinusitis. RESULTS: Thirteen percent of CCGs had restrictive referral criteria in place, largely unrelated to published evidence-based guidance. The routine use of multiple courses of oral steroids, prescription of antibiotics, CT scanning within primary care, and delaying referral for a year, prior to referral to a specialist were recommended against published advice. CONCLUSIONS: Restricting access to surgery may contribute to poorer outcomes and a decrease in the patient's quality of life. This is against the NHS constitution and is open to legal challenge. We encourage all ENT surgeons to review policies of their local CCG and engage with commissioners to ensure that their patients have evidence-based care.
OBJECTIVES: To assess the compliance of clinical commissioning groups (CCGs) in England with the ENT-UK rhinosinusitis commissioning guide produced in collaboration with the Royal College of Surgeons England and the National Institute of Clinical Excellence. We also aimed to assess the ease of accessibility of data from CCGs. DESIGN: Audit of compliance of English CCGs with the ENT-UK rhinosinusitis commissioning guide. SETTING: CCGs in England PARTICIPANTS: A total of 58 of the 221 CCGs in England were included and chosen because they were the first CCGs authorised by NHS England, or alternately, the CCGs forecasted to have a deficit in their first year of operation. Their websites were reviewed; when information was not easily accessible, a freedom of information request was submitted to the relevant CCG. MAIN OUTCOME MEASURES: Compliance with commissioning guidelines for rhinosinusitis. RESULTS: Thirteen percent of CCGs had restrictive referral criteria in place, largely unrelated to published evidence-based guidance. The routine use of multiple courses of oral steroids, prescription of antibiotics, CT scanning within primary care, and delaying referral for a year, prior to referral to a specialist were recommended against published advice. CONCLUSIONS: Restricting access to surgery may contribute to poorer outcomes and a decrease in the patient's quality of life. This is against the NHS constitution and is open to legal challenge. We encourage all ENT surgeons to review policies of their local CCG and engage with commissioners to ensure that their patients have evidence-based care.
Authors: Carl Philpott; Steffi le Conte; David Beard; Jonathan Cook; William Sones; Steve Morris; Caroline S Clarke; Mike Thomas; Paul Little; Jane Vennik; Valerie Lund; Helen Blackshaw; Anne Schilder; Stephen Durham; Spiros Denaxas; James Carpenter; James Boardman; Claire Hopkins Journal: Trials Date: 2019-04-29 Impact factor: 2.279
Authors: Jane Vennik; Caroline Eyles; Mike Thomas; Claire Hopkins; Paul Little; Helen Blackshaw; Anne Schilder; Jim Boardman; Carl M Philpott Journal: BMJ Open Date: 2018-12-19 Impact factor: 2.692