Demand optimisation in diagnostics: standardising diagnostic testing in NHS Boards

Section 7: Recommendations

The NDOG recommends the following:

1. Guidance - NHS Boards should adopt the recommendations within the General Demand Optimisation Guidance and IT Guidance documents produced by the NDOG (Appendices C and F).

2. NDOG Related Workstreams - The NDOG (revised as an implementation group) should continue to function into 2017, and beyond, to allow coordination and support for Demand Optimisation work streams and strategy implementation. The following work streams should be taken forward in collaboration with local Health Board leads, the Diagnostic Networks and the NHS Scotland Shared Services Health Portfolio:

2.1. Data Management. Data collection and reporting is a key enabler for all future work and will underpin all the work streams. This should be taken forward within existing work in the NHS Scotland Shared Services Laboratories project to meet the requirements set out for Demand Optimisation. The necessary resource allocation to allow local data collection with national level collation, analysis and presentation needs to be considered.

2.2. Service Variation. This workstream needs to identify variation across NHS Boards both in terms of scope of available services and the actual use both in primary and secondary care. Regular collection/collation of data would allow an Atlas of both service and variation to be generated which would not only provide a snapshot but act as a rolling baseline to gauge progress.

2.3. Requestor Feedback. A common, consistent approach to providing requestors with information around their own activity should be considered. This information could be accompanied with peer comparison data, best practice guidance and related test cost data.

2.4. Minimum Retesting Intervals ( MRIs). Existing guidance on MRIs in lab tests should be consistently implemented across all NHS Boards to reduce unnecessary repeat testing. Addressing related IT bottlenecks needs to be prioritised.

2.5. Introduction of New Tests/Pathways. A more focused and collaborative workstream aimed at facilitating the introduction of new tests within definitive clinical pathways should be initiated. This effective diagnostic pathway approach could also be applied to existing tests.

2.6. Realistic Radiology. The Scottish Clinical Imaging Network will establish a Short Life Working Group to engage with the recommendations made by the NDOG with regard to imaging. This will include evaluating various clinical decision software options, with a view to piloting a preferred option in the near future

3. Information Technology ( IT). Shortcomings in IT functionality and lack of interoperability between systems limit the scope for successful demand optimisation strategy implementation. The Scottish Government, the shared services portfolio group, existing diagnostic networks and NHS eHealth leads should collaborate to explore solutions that would allow:

• Regular, consistent and automated data collection around diagnostic test activity.
• Improved standardisation across information systems, read codes and data repositories.
• True interoperability across systems.
• Optimum functionality for implementation of minimum retesting intervals including "live blocking" of inappropriate requesting.

Fast tracking developments to support demand optimisation, with an initial focus on minimum retesting intervals, should be explored as part of this.

4. Oversight, Collaboration and Governance. The success of any demand optimisation programme relies heavily on clear collaborative governance structures existing both centrally and locally within the NHS Boards. Much of this already exists but requires re-defining and prioritising. The following recommendations are made:

4.1. NHS Boards and Diagnostic Networks should continue to provide support to healthcare science leads, managers and diagnostics staff to work with the national healthcare science leads and diagnostic networks in collectively progressing Demand Optimisation work.

4.2. The national Diagnostic Steering Group ( DSG) should consider establishing an authorising subgroup made up of Board diagnostic services managerial and clinical leads to decide on, prioritise and approve NDOG/ NMDN recommendations including those related to demand optimisation.

4.3. NHS Boards should put in place structures that will enable Demand Optimisation strategies to be considered and implemented. This will require:

• Involvement of not just the diagnostic services but also that clinicians from Primary and Secondary Care, managers and finance are fully engaged as integrated teams to ensure delivery of optimal diagnostic services.
• Identification of a Demand Optimisation Lead (Board-level executive lead for Healthcare Sciences) to oversee the development of local infrastructure and enable linkage of local diagnostics demand optimisation activities

4.4. Diagnostics service providers and users should be mandated by Boards to:

• Develop an embedded focus on diagnostics demand optimisation within their management and operational delivery structures.
• Engage in national and local data collection activity to identify overt variation in user practice and gaps in repertoire.
• Monitor demand optimisation strategy effect on local improvement in clinical outcome and/or efficiency of the service.
• Feed back good practice examples into the existing test case library ( appendix B) - this will be managed by the existing NMDNs.

4.5. The relevant National Diagnostics Managed Network should provide national oversight and consistent quality, with operational leads for each discipline from each providing NHS Boards. Where national networks do not exist for a particular discipline, a community of practice should be established and supported, linked to Scottish Government's Healthcare Science Lead

4.6. Biannual reports from all disciplines should be provided to the Diagnostic Steering Group via the national networks or via the Scottish Government's Healthcare Science Lead, where no relevant network exists.