Clinical Lead, John Abercrombie
John has held the role of General and Colorectal Surgeon at Queen’s Medical Centre, Nottingham since March 1998. His particular interests are complex inflammatory bowel disease, intestinal failure, and abdominal wall reconstruction, and he is also a screening colonoscopist.
John has been a member of the Council of the Royal College of Surgeons of England since 2013. He qualified from St Bartholomew’s Hospital and was trained in the North East Thames scheme, one of the last senior registrars to complete the scheme.
National report on general surgery: How to improve clinical quality and efficiency
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Professor Derek Alderson, President of the Royal College of Surgeons:
“The Royal College of Surgeons is a strong supporter of the Getting It Right First Time initiative which has shone a light on variation in surgical practice and processes across the NHS. Surgical change is most effective when driven by surgeons themselves and we are pleased to see this report is no exception to that principle. As a professional body that exists to advance surgical care, we believe the recommendations have the potential to improve the quality and experience of care that patients receive, as well as deliver important savings to the health service.”
The General Surgery report from the ‘Getting it Right the First Time’ (GIRFT) programme sets out key recommendations to improve the standards of clinical quality and efficiency across NHS hospital trusts. The report found that by reducing unwarranted variation between hospitals in areas such as effective procedures, length of stay, infection rates and procurement costs will improve patient outcomes and help the NHS save £160m in efficiencies each year.
The GIRFT general surgery programme, led by colorectal surgeon John, reviewed data from all acute hospitals in England and John and his team visited 50 general surgery departments. Based on analysis and evidence, the report makes 20 recommendations for the NHS and its partners to implement over the next three years to ensure that patients are receiving the high-quality of care they expect and deserve.
The general surgery report is the first to be published since the GIRFT methodology was rolled out to cover more than 30 specialties.
Five key themes were focused on throughout the report, with 20 recommendations for trusts, the NHS and its partners across these areas:
- Data and Performance;
- Procurement Change;
- Commissioning and Care Pathways;
- Surgical Performance; and Efficiency; and
- Emergency provision.
Other opportunities to improve patient care and outcomes, and deliver potential efficiencies of over £160m annually, include:
- A reduction in the length of stay for elective colorectal surgery patients from the current average of 10.2 days to the 5.5 days in the best performing hospitals, would ensure patients didn’t have to stay in hospital for so long and would free up to 84,000 bed days, equivalent to a saving of £23.6m.
- A reduction in the length of stay for appendicectomy patients from an average of 3.5 days to 2 days would ensure people were back home more quickly and would free up 30,000 bed days for other patients, equivalent to a cost reduction of £8.5m.
- Reducing elective general surgical admissions without any surgical procedure, which are rarely necessary, would save close to £7m a year.
- Reducing some hospitals’ high levels of emergency readmission at 30 days for gall bladder surgery to the national average would save £1m in bed days.
- Similarly, if providers with high 30 day emergency readmission rates following appendicectomy reduced their readmission rates to the national average, this would free up £5.8m worth of bed days.
- If all patients received gall bladder surgery within 14 days of diagnosis, as opposed to the national average of 23% of patients, more people would be treated in a timely fashion with fewer readmitted for later surgery, and up to £5m saved.
- If all trusts reversed surgical stomas following colorectal cancer resection, where appropriate, in the recommended time frame of 6 months rather than 18 months, this would provide a better experience for patients and could save almost £2.4 million annually.
- For a basket of surgical supplies, procurement costs varied from £1,467 to £2,336. If all hospitals procured these items at the lowest price, national costs would reduce by 59%.
Information for NHS Trusts
The general surgery review visits to acute hospitals are ongoing and all relevant NHS Trusts have either already been visited or will be visited by the end of 2017. Trusts seeking information on visits can contact the general surgery Project Manager, Caroline Ager, at firstname.lastname@example.org
Findings from those visits will feed into the implementation process, which will provide tailored implementation plans for every hospital to meet local needs. GIRFT will also work nationally with a wide range of clinical, governmental and public bodies to design a series of complementary levers that will help trusts to deliver the recommendations on the ground. A number of trusts have already begun to take action in response to some of the opportunities identified.
The aim is that the report serves as the catalyst for further discussion and action, at national, trust and individual surgeon level, to enhance patient care, improve outcomes from general surgery and drive efficiency. We will be back in touch with trusts in the Autumn with more details on how we will be supporting trusts to meet the opportunities in this report and other GIRFT work.