This article relates to the CQC key question: Is your practice effective?
Dr Jonathan Botting, clinical lead for minor surgery at the Royal College of General Practitioners (RCGP), has developed an audit tool with the Health & Social Care Information Centre (HSCIC), which will help you to demonstrate outstanding practice in minor surgery.
Who should be using audits?
If your practice undertakes any form of minor surgery you should be involved in audit: audit of your results, your complications and of your diagnostic accuracy. Diagnostic accuracy is particularly important for those providing any form of community-based skin cancer surgery.
But those offering more of a ‘lumps and bumps’ surgical provision should also audit their service (see Clinical audits). Audits should be undertaken regularly and used to help evidence a doctor’s standards and competence to perform an extended role. (A procedure involving surgery with a scalpel would count as an extended role.)
Audit can look at the service from the patients’ perspective (patient satisfaction survey) or from the clinical perspective. Clinical audits should include both activity and quality of surgery (in terms of diagnostic accuracy, completeness of surgery and complications). Best practice would be to compare individual results to national results and to compare quality of surgery over time.
The Community-Based Surgery Audit
The RCGP has collaborated with the HSCIC to develop a Community-Based Surgery Audit (CBSA), which will provide evidence to CQC of the highest standard.
So what is the CBSA?
Firstly, the CBSA acts as a surgical log. It enables users to record not only their surgical activity but also their diagnostic accuracy (compared to histology), their surgical skill (looking at completeness of excision) and their complication rates.
Secondly and most uniquely, the CBSA allows clinicians to compare their activity, their skills and their complication rates to their peers (those operating under comparable governance). This unique reporting system is similar in principle to that found throughout secondary care to allow units to benchmark their quality.
The information generated will provide commissioners with the evidence they need to support investing in the service. It will allow community surgeons to demonstrate the necessary credentials for revalidation and meet the requirements that the responsible officer will have to ensure that a doctor is fit to provide a surgical service in the community.
Using the online CBSA system
Signing up to use the system is free. All you need is an nhs.net email address. Entering data might seem time-consuming at first, but that speeds up rapidly with use. Plus, in order to avoid duplicating entries into both clinical systems and the online CBSA audit system, GPs can download their collected data and use it to populate their clinical notes as well as provide evidence of activity for funding purposes.
An anonymised report from the audit:
- Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection