National programme update

Patrick Rankin, NDESP National Manager

Public Health England leads the NHS Screening Programmes

8 Months in…………..• Honoured and privileged to be leading the DES programme nationally

• Huge amount of experience and excellent work out there across the country

• Utilise this expertise to continue to improve the programme

• What have I learned….?

• Diplomacy

• Prioritisation

• Juggling

• Skype

• Working on the train!!

2 National update

National team• Data: Donna Prentis

• IT: Andrea Procter and Adam Gregory

• Grading: Shelley Widdowson

• Screening intervals: John Fox

• Communications: Mike Harris

• Education and training: Tsitsi Muchayingeyi

• Quality assurance portfolio lead: Madeleine Johnson

• National programme manager: Patrick Rankin

• National programmes lead: Anne Stevenson

Our roles are to support the strategic and operational delivery of the screening

programme by providing local programmes with the policy, procedure and data

to effectively and safely provide a quality assured screening programme

National update3

Key priorities 2017/18

• GP2DRS rollout

• Screening intervals and associated IT

• Grading improvement to support screening intervals

• Qualification support

• Appropriate oversight of the programme

• Reform the programme advisory group

• Communicating with programmes

• GOV.UK and documentation review

• Pathways and HES failsafe

• Ongoing process over the next couple of years

4 National update

Another year on……

• Programme eligible population

3,165,936 - up 272,813 (9%) from 2015/16

• Number screened (RDS)

2,248,277 – up 224,392 (11%) from 2015/16

• Number of programmes

66 – down 4 from 2015/16 (now 62)

6 months in....!5

2016/17 NDESP KPIs

2015/2016 2016/2017

DE1 (uptake of RDS)

83.0% 82.2% Acc ≥ 70% Achi≥95%

DE2 (results in 3 weeks)

96.5% 96.5% Acc ≥ 70% Achi≥95%

DE3 (Urgent referrals)

79.8% 75.4% Acceptable ≥ 80%

6 National update

Provisional uptake of RDS by CCG,

2015/16

National programme update

Data not available for

all areas

7

Provisional rate of ungradable images per

100,000 screens by CCG

National programme update

Data not available for

all areas

8

Provisional rate of urgent referrals (R3A) per

100,000 screens by CCG

National programme update

Data not available for

all areas

9

Demographic information support

• During the update to the programme software a number of additional fields

were added around demographics

• To helps support local programmes in health needs assessments, CQUINS,

demographic and ethnicity

• Additional fields have been added to support the NHS accessibility

standards from 01 April 2017.

• Guidance has been produced and is available on GOV.UK

• Is not mandatory for programmes to ask all the fields

10 National update

NDESP pathway standards• The new NDESP pathway standards were published in March 2017

following and 18 month development process

• Clearer, easier to understand and interpret

• 19 standards down to 13

• Standards relating to the structure of the programme, single collated list,

work-force/training have been removed and incorporated within the service

specification

Added standards relating to:

seeing pregnant women in digital surveillance

timeliness of recall in digital surveillance

timeliness of recall in slit lamp biomicroscopy

people with diabetes not attending an appointment in three years

NDESP monitoring the returns and quality of the programme performance

report to the new standards ensure robust data

11 National update

• NDESP has been working with the 3 software suppliers to determine

changes to the software

• Reviewed digital surveillance pathway reporting to take into consideration

the variable appointment times

• EMIS has been unable to upgrade local programmes to new software for

pathway standards

• KPI data and collection has been delayed by 3 months to allow EMIS to

implement changes

• HISL and HI have been able to implement new standards and reporting

12 National update

Patient pathways• updated and published on GOV.UK, now includes pathways for:

• Retinal screening

• Referral for digital surveillance

• Referral for slit lamp biomicroscopy surveillance

• Referral for diabetic retinopathy

• pregnant patients

• Baseline screen when informed

• Digital surveillance or HES

• Rescreen 16-20 weeks

• Rescreen 28 weeks

• R1M1 and above at any screen referral to HES and monitor for 6 months post

pregnancy

• NICE recommendation

National programme update13

GP2DRS

• A number of programmes are rolling out GP2DRS

• It is identifying patients previously unknown to the screening

programmes

• 2-3% of additional capacity

• Further programmes to be identified/volunteer for roll out in the

coming months

• Programmes will need to consider additional capacity to cope with

the potential increase in patients

• Phased rollout acceptable

• Added to service specification in 2018/19 as recommended method

for cohort extraction (unless more functional system is used)

• Free to local programmes

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Screening intervals

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Screening intervals update• Study showed it was safe to implement screening intervals

• Releases capacity within programmes

• Cope with the increasing diabetic population (5%pa)

• Help programmes concentrate capacity for harder to reach groups

• Improve uptake

• Screening programmes should not be testing if not clinically appropriate

• UKNSC recommendation 2016:

• Extend screening intervals to low risk group

• Quality grading

• Robust data and IT processes in place

16 National update

Screening intervals update• Following UK NSC recommendation to implement 2 yearly screening

intervals NDESP initiated project to support the project

• Implementation group developed

• NHSE, PHE, DUK, SIT, programme staff

• Work-streams include:

• IT

• Grading quality

• Implementation

• Comms/education

• Patient engagement

• IT and screening intervals were intrinsically linked for the project

• PHE screening led on the IT solution, this took longer than expected

17 National update

Screening intervals update• The screening intervals implementation group was put on hiatus until IT

situation was confirmed

• Progress of screening intervals was linked to a single IT software solution

• Following discussions with NHSE three potential IT options:

• existing software suppliers

• one of the existing software suppliers

• new national It system

• PHE and NHSE currently determining which option is best suited to deliver

screening intervals

• cost effective

• improve grading

• robust data and IT

• 2018/19 service specification should outline the process for 2019/20

18 National update

Diabetic population

• Over the past 2-3 years that has been a high increase in the eligible

population for screening

• 2015/16 eligible population = 2,893,123

• 2016/17 eligible population = 3,165, 936

• 9% increase in eligible population

• Developing a report to determine if we can identify what has caused

this increase

• Health checks, electronic extraction methods, improved reporting?

• Start working with NDA, DUK, NHSE to understand implications

19 National update

OCT best practice guidance

• NDESP has begun the process to develop some best practice

guidance for the implementation/provision of OCT within local

programmes

• Will need to be commissioned and funded separately from the

screening programme and pathway

• Some programmes are already undertaking OCT

• Likely to utilise digital surveillance

• Briefing document is being developed followed by workshop with

stakeholders in Jan/Feb to determine best approach

20 National update

Communications and blog• PHE screening blog is the mechanism for communicating majority of

national change to programmes

• NDESP has a rolling cycle of blogs ready to go

• 2nd most blogs/screening programme (1-2/month)

• GP2DRS

• TAT

• Qualification

• Cohort management

• Pathway standards and KPI’s

• 22 November 2017 , National networking day, Birmingham.

• 20 April 2018 RSM/NDESP National conference

21 National update

22 National update

Future developments

• GOV.UK pages to be reassessed

• Documentation re-appraisal and simplification

• Full GP2DRS roll out

• Grading projects implemented

• OCT best practice guidelines/UK NSC recommendation

• Automated grading research/introduction

• Apprenticeship for screener qualification

• Elearning to support registrar ophthalmologists

National programme update23

24 6 months in....!