How can I demonstrate quality improvement when undertaking a new or rare procedure in my independent sector practice?

This case study will help if you:

  • use surgical or other interventional procedures
  • practise in the independent healthcare sector
  • undertake procedures that may be considered new or rare.

The National Institute for Health and Care Excellence (NICE) worked with us to develop this case study. NICE’s interventional procedures guidance applies across the UK. However, other NICE guidance products may not always apply across the four countries of the UK, and we therefore recommend speaking to your employer if you have any questions.

Key point to consider

  • Your appraiser, employer or professional membership body can offer advice on what information to bring and how to present it. The NICE website also has guidance relevant to different areas and types of practice that might help you.
  • Your employer should provide you with the opportunity to participate in national and local audits if one is being conducted in your area of practice. Your employer should also give you appropriate data to allow you to reflect on the outcomes of audits.
  • National guidelines and quality standards relevant to areas of your practice can be used to guide the information you provide for your appraisal as well as reflection and discussion.
  • Any new techniques and procedures you use should be overseen by appropriate governance structures, which may include seeking authorisation from your hospital’s novel interventional procedures committee. 

Scenario – Dr Wade

Dr Wade is a consultant gastroenterologist working across the NHS and independent sector.

As part of her independent sector work, she performs an endoscopic intervention for gastro-oesophageal reflux which is not commonly undertaken. She is considering how to meet the requirements for appropriately demonstrating quality improvement across her whole practice.

How the doctor met our requirements

Before using this technique she presented information to her hospital’s medical advisory committee. This was in line with the policies of the hospital in which she works and national guidance, including the Independent Healthcare Providers Network’s Medical Practitioners Assurance Framework. The committee reviewed her submission and noted NICE’s interventional procedures guidance. The guidance advised that, because of the limited existing evidence to support safety and efficacy, the procedure should be subject to special arrangements for clinical governance, consent, and audit or research.

They agreed that she could proceed with the technique with an initial and defined number of cases. They required her to carry out an audit of these cases using the audit tool in NICE’s guidance. They agreed that she would report back to the committee on outcomes, including whether there were any adverse events. They also agreed that as part of the consent process with patients, she would highlight the uncertainty of the procedure's safety and efficacy and provide clear written information.

At her appraisal, Dr Wade:

  • presented quality indicators and outcomes (including sedation-related) for endoscopic procedures in both her NHS and private practice. These were referenced to quality standards published by the relevant professional society. Her NHS Trust and independent hospital helped her extract the relevant data. As she’d also led a departmental audit of sedation practice and outcomes during upper gastrointestinal endoscopy, she was able to compare her own performance with that of her colleagues.
  • discussed outcomes from her planned and emergency endoscopy practice. There were no significant areas of deviation from expected outcomes or gaps in the data.
  • presented immediate and medium-term outcomes data for the interventional endoscopy procedure she performed in her private practice. She used the NICE-recommended audit tool and reported symptom scores at each follow up appointment. Given the lack of established quality standards for this procedure, she referenced her performance against outcomes data reported in published studies and case series. To provide additional context, her appraiser suggested that she identify other practitioners performing the same procedure and seek to compare practice and outcomes data with them. They agreed that she would undertake this during her next appraisal cycle.
  • reflected on her outcomes and practice and on the risks associated with undertaking such procedures and how these can be managed in practice.