InHealth Endoscopy operates seven purpose built community diagnostic endoscopy sites across the south of England, providing around 20 000 procedures per year to the NHS commissioned through AQP contracts. All sites are CQC registered and are JAG compliant when built. Currently, 4 of the sites, including Braintree have JAG accreditation and another 2 sites have visits planned later this year.
Our purpose is to provide rapid access high quality diagnostic and minor therapeutic endoscopy for local patients, and to support GP’s with a clear and thorough report and management plan for their patients that enable them to continue with primary care management wherever possible. The service we offer is direct to test and we have found that with clear referral criteria, GP education and triage of referrals, there are very few patients who are deemed unsuitable for their procedure on the day. This direct to test pathway is both faster, with waiting times maintained at 2-3 weeks in all units, and provides a one stop service with no need for an outpatient consultation. There are also savings for the commissioner in this pathway.
We always provide education and feedback to GP’s, and see a key purpose in the service to help provide advice and guidance on a wide range of common GI problems. A key feature of our service is that all patients will received a detailed report supported by a conversation with the Endoscopist on the day of their test. This report is also sent to the patients GP the same day. Patients who require onward referral to the MDT are referred via our care pathways and clinicians meet to discuss cases and ensure that any transfer of care is smooth and seamless.
Braintree is one of our longest running sites, operating in partnership with Mid Essex HealthCare Trust and Provide, the community provider. The Braintree site is also our busiest, working 3 session days and seeing around 500 patients per month. We have recently introduced capsule endoscopy; however the majority of our work continues to be Trans nasal endoscopy, flexible Sigmoidoscopy and colonoscopy.
Patients travel to the service from mid and Central Essex, and our natural catchment area population is around 400000. We plan that around 1% of the population is suitable for a community based diagnostic endoscopy, and we are currently seeing slightly over this ratio from the local community. We have found that a one hour journey time is acceptable for patients. Community facilities often provide a less stressful and more welcoming environment for patients, as parking is free and finding the department is easier.
Our aspirations for the future are to continue to form close working relationships with our NHS partners and to become a site from which additional services and capacity can be offered, such as
· Bowel Scope and other screening
· Providing a 2ww service
· Waiting list work for local trusts
· GI GPSI or Nurse lead clinics and
· Digestive Disease Centres
We also want to offer a clinical assessment service to assist referring GP’s to make high quality and timely referrals, which are evidenced based and follow best practice. Over the next few years we expect to see a shift in case mix towards more Colonoscopy and fewer OGD’s.
Each site has monthly unit meetings chaired by the clinical lead and six monthly quality circle meetings. An annual governance meeting is also held attended by the clinical staff. Every six months a detailed submission called the Global Rating Scale is submitted to JAG which enables comparison across all services submitting data in the UK. This focus on outcome and completion data has driven up standards in all services in the UK that are part of JAG.
We collect data from our clinical system on completion rates, biopsies retrieved, use of sedation, comfort scores and other metrics and compare these against the benchmarked standard (e.g. BSG outcome data). This enables our clinical team to be evaluated and this information is used in appraisal and training. For example, the completion rate nationally for Colonoscopy is 90%. At Braintree the 11 of the 13 Colonoscopist’s have a completion rate above this figure. Finally, our rate of perforation, a known complication in endoscopy, is less than 1:10 000. This compares with a national benchmark of 1:1500
We are the only provider that routinely offers this test for patients. Since we have started providing the service, we have carried out thousands of tests and find that patient satisfaction is very high and the low use of sedation has meant that this is an ideal procedure for the community and have recently uploaded a video on trans nasal endoscopy onto Youtube.
A detailed review of 1200 patients has shown that the detection rate for Barrett’s Oesophagus is the same in the trans nasal group as in those patients having an oral gastroscopy.
Resources for patients and referrers
All units have a comprehensive library of information on a common range of GI conditions that patients can take home with them after their appointment. We have also developed our website wwww.inhealthendoscopy.co.uk. Looking ahead, we aim to continue to develop our on line resources and links with other organisations.