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Endoscopy Commissioning

Commissioning an endoscopy service can be a complex process. The principles and resources outlined in this section should be adopted.

Service
Gastrointestinal endoscopy is critical for the investigation of patients with gastrointestinal symptoms as well as for screening for bowel cancer. The discipline encompasses diagnostic and therapeutic interventions delivered from a range of hospital and non-hospital locations.

Any endoscopy service should set its activity around the needs of the patient. The appropriateness of endoscopic investigations should be measured against local or national standards (e.g. NICE guidelines for dyspepsia management). The patient experience should be continuously monitored and fed back into the service. Both these indices constitute important elements of a service’s Global Rating Scale or GRS.

Quality and Safety
Any endoscopic intervention should be of demonstrable quality with audit data on measurable outcomes and recording of common complications (GRS). Decontamination of endoscopic equipment must comply with national standards (HTM-01-06). Each service must express clear governance mechanisms and procedures to accommodate any infrequent but serious complications.

People
Endoscopists should all be able to demonstrate standards of care with activity and outcome data. Each will be expected to achieve JAG Accreditation. Equally nursing staff working in endoscopy should demonstrate adherence to an established competency framework. Services should demonstrate commitment to established national endoscopy training programmes (i.e. GIN).

Finance
Although the national tariff determines costs associated with individual endoscopy procedures in NHS Trusts commissioners will need to assess the cost effectiveness of any given endoscopy service. This will be influenced by the range of endoscopic services provided by a unit and the anticipated volumes of activity.

Growth
Any successful and productive endoscopy service must ensure sustainability of its service. This will be determined by a continued commitment to growth and service development. This requires continuous two-way communication with referrers and other endoscopy units in the locality/region.

Competencies
World class commissioning competencies describe the knowledge, skills, behaviours and characteristics commissioners will need to reach world class status. 

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