National Demand Optimisation Group (Ndog) – Phase 3 Report

7 Impact of the COVID-19 Pandemic

As with every other area of the NHS, and the country as a whole, the effect of COVID-19 has had an impact on the Demand Optimisation programme. As the COVID-19 threat increased, all health professionals were instructed to set aside all non-essential work that was not COVID-19 related and use all their resources to concentrate on the pandemic. As such, programmes like the Demand Optimisation programme have in effect been largely paused.

Anecdotally, the shift of focus of healthcare towards the pandemic has resulted in dramatic effects on laboratory test use with many NHS Boards reporting reductions of around 75% in overall test use due to overall under activity in more routine clinical services. This will clearly have significant impact on any longitudinal observations on test requesting trends during this time period and likely into the near future. These deviations may make the effectiveness of demand optimisation intervention more difficult to assess fully.

Therefore, a number of planned objectives within Phase III have been left unfulfilled. Whilst all referrers who had requested access are now users, any direct interaction with GPs and the subsequent piloting of the Atlas in NHS Lothian has been put on hold. In addition, the future events where the Atlas may be showcased (and have accepted abstracts) e.g. NHS Scotland Event, ACB focus conference, Scottish Clinical Immunology Group (SCIG) have been postponed and, in many cases, with no rescheduled dates. This will undoubtedly impact on the significant traction the Atlas has recently gained with primary care, especially during Phase III.

The magnitude of the COVID-19 situation also affected engagement with laboratories. Routine data collection had been established and so some laboratories have continued to provide data returns; however, this was halted in several NHS Boards. In addition, as regular specialist network meetings were postponed, the data interrogation and expert view on production of educational material roles were significantly reduced.

Quality Improvement work was a key part of Phase III, however national networks and specialist groups did not have the capacity to report on the many great Quality Improvement initiatives undertaken throughout the country and there is no currently available outcome data to report. A list of the QI work underway is listed in Appendix F.

The return of conventional NHS services at this point presents an opportunity to optimise demand as testing increases again. It is strongly recommended that National Demand Optimisation work is re-commenced in preparation for this. The need for appropriate, targeted use of diagnostic tests will likely be even more important for the NHS in the near future.

In response to the changing healthcare landscape during the COVID-19 pandemic, focus of the programme transformed to monitor laboratory test use during the COVID-19 pandemic and recovery phases – this work has begun as Phase IV of the programme. It is anticipated that such data collection, analysis and subsequent dashboards can help identify healthcare gaps created during the pandemic and inform prioritisation decisions during remobilisation. In addition, identifying laboratory workflow issues, especially as remobilisation progresses, will enable laboratory resource pressures to be identified and addressed more easily.

To reflect the current status of this funded Phase IV COVID-19 pandemic monitoring project at the time of writing, an addendum has been added at the end of this report to reflect early progress with this work: Lab Activity as a Metric for Pandemic Healthcare Trends (see Section 11 Addendum).

Unwarranted variation in the use and availability of laboratory tests will not be resolved rapidly and will require continual refinement and monitoring. It is vital that a National Demand Optimisation oversight is retained, both for the newly focused Phase IV pandemic monitoring programme and beyond, so that previous momentum and achievements can be built upon and the drive towards appropriate test use is supported to continue. Appropriate laboratory testing will be even more important in shaping prioritisation and driving recovery and remobilisation in a very changed healthcare landscape – ongoing funding of the programme is essential.