As many readers will know, the specialised services commissioned by NHS England have been grouped into six National Programmes of Care (NPoC); endocrinology lies within the NPoC for internal medicine. Each NPoC has several Clinical Reference Groups (CRGs) to provide clinical advice and leadership. These groups of clinicians, commissioners, public health experts, patients and carers use their specific knowledge and expertise to advise NHS England on the best ways that specialised services should be provided. In April this year, NHS England published the outcome of a 30-day engagement period with stakeholders on proposed changes to CRGs and their membership. Further information on the changes to CRGs can be found in the engagement outcome report.¹

 

THE SITUATION FOR ENDOCRINOLOGY

We are delighted that, with our work ongoing, NHS England saw fit to continue our Specialised Endocrinology CRG in its recent review. We see this group as important for the further development and identity of endocrinology as a specialty. Our CRG works alongside many other clinical specialty groups that advise on specialised commissioning and quality assurance, and thus developments in our field are often somewhat slower than we would wish. That said, we have recently been very successful as a CRG in the NHS England Annual Prioritisation process that determines investments and changes in commissioning for specialised services in the future. A number of endocrine drug policies have made it through this stringent process, which will in future allow greater transparency and more objective access to some of our less frequently used and more expensive drugs.²

 

REVISED CRG FORMAT

The Specialised Endocrinology CRG will reform again soon in a revised format. With growing recognition of the importance of contributions by senior clinicians to the CRG, the Chair will, in future, be remunerated for one session per week. There will be representatives from around the country, as well as representatives from learned societies, such as the Society for Endocrinology. Members of the Specialised Endocrinology CRG can be seen on the NHS England website.³ I am currently Chair and Neil Gittoes (Birmingham) is the Deputy Chair.

 

ENDOCRINOLOGY DASHBOARD

We also wanted to update you on the specialised endocrinology dashboard. This will attempt to quality assure endocrinology services and will help endocrine units develop clinically meaningful standards of care throughout the country. There will be several criteria on the dashboard that will be recorded locally by Trusts and fed through to NHS England. We have developed these with Petros Perros (Newcastle upon Tyne) and based many variables on the peer review hospital visiting system for endocrine departments that the Society for Endocrinology developed and which has been in place for some years. Thus, in the ‘new world’, our Trust managers are likely to ask for data regarding our endocrine activity.

The criteria which will be monitored by NHS England as a result of this as a ‘specialised endocrinology dashboard’, include the following:

1. Time to appointment from referral to specialist endocrinology.
2. Time to sending GP letters from outpatients from outpatient appointment time.
3. Time to sending inpatient summary to GP from inpatient episode.
4. Lab turnaround times – proportion of samples within 14 days for aldosterone, plasma and urinary catecholamines.
5. Time to measurement of prolactin and cortisol – proportion of samples assayed within 3 hours.
6. Time to diagnostic endocrine tests – insulin tolerance test.
7. Time to dynamic tests – glucose tolerance test.
8. Time to pituitary surgery from multidisciplinary team (MDT) meeting. a) Cushing’s and urgent surgery – visual pathway problems and pituitary bleeding. b) Time to routine pituitary surgery from MDT decision.
9. Length of stay for adrenal surgery.
10. Length of stay for non-functioning pituitary adenoma operations.
11. Length of stay for Cushing’s disease surgery.
12. Patient survey within the last 2 years.
13. Presence of transition clinics.
14. Time to genetic counselling when necessary. This is obviously only a selection. We have tried to come up with a list of sensible things that are reflective of best endocrine practice. Hopefully, it will not be too difficult to obtain the data.

It will be important for endocrine teams to work effectively with their local contracting teams to help ensure that this is delivered in the manner intended. If you have any queries or suggestions for further developments, please let the Specialised Endocrinology CRG know.

John Wass

Professor of Endocrinology, University of Oxford Chair, Specialised Endocrinology Clinical Reference Group

 

REFERENCES

1. NHS England 2016 Revisions to Clinical Reference Groups in Specialised Commissioning: Engagement Period Outcome Report http://bit.ly/2bc5hQd.
2. NHS England 2016 NHS England announces provisional investment decisions for specialised services http://bit.ly/2aYkI0A.
3. NHS England 2016 Clinical Reference Group on Specialised Endocrinology http://bit.ly/2b5eQBl.