The commissioning process of national clinical audit programmes

Topic prioritisation is the term given to the process that NHS England undertakes – with advice from the National Quality Board NCAPOP Partners Subgroup that includes HQIP and the National Quality Improvement (including Clinical Audit) Network (NQICAN)– to systematically prioritise which clinical care areas are covered by the NCAPOP.

Projects are selected for inclusion in the NCAPOP based upon on a number of factors which include:

• Alignment with overall NHS England and Welsh Government priorities
• Impact and value for money
• Need, including care quality and outcomes and variation in care quality and outcomes
• Professional and patient/carer support
• Alignment with other national activities

Every project within the NCAPOP has been established to address a clinical area (or areas) where healthcare improvement is required, and the common aim of each project is to have a positive impact on patient care.

HQIP holds Specification Development Meetings (SDMs) to support the development of high quality service specifications against which tender returns can be invited.

An SDM is divided into two parts:

• the first part where the discussion centres on the potential improvement focus and key features for the proposed future programme as well as the benefits and risks associated with those features. This typically includes representation from: the funding body; key professional stakeholders and those who have specific expertise related to the programme; patient/carer/parent voice partners; audit professionals and potential bidders for the project.
• The second part of the SDM involves HQIP, public and patient representation, funders and their advisors. The key features of the programme specification are agreed. Part 2 of the meeting marks the start of the procurement phase for the project and potential bidders or those with conflict of interest are excluded.

Once a specification has been developed, HQIP commences a formal tendering process and welcomes tenders from potential bidders. All contract opportunities are published on HQIP’s website as well as those publications and websites required by procurement legislation (currently covered by EU legislation).

Tenders received are reviewed and scored against the criteria that were outlined in the formal invitation to tender. The reviewing panel usually includes representatives from:

• HQIP
• the funding bodies (such as the NHS England National Clinical Director),
• the clinical specialty
• Representation of the patient/carer/parent perspective

HQIP contracts usually run for between 3 and 5 years. If it is agreed that an audit topic will be re-commissioned, and a seamless continuation of the project is required, HQIP will aim to begin the retender process typically 12 months prior to the end of the current contract.

Once a contract has been awarded, appropriate governance arrangements and structures are put in place by NCAPOP providers to ensure successful delivery of the project and to safeguard public funding. The provider is also responsible for ensuring that it, and any other data processor contracted as part of the project, are compliant with all data protection laws and information governance requirements.

Contract review meetings

HQIP organises and chairs regular contract review meetings (CRM) with each provider to monitor performance on behalf of the funders (e.g. NHS England, Welsh Government, etc.), against the following requirements:

• Contract
• Deliverables
• Resources (for example finances)

As well as documenting and monitoring delivery progress, the contract review meetings present an opportunity to identify risks, issues, and challenges which can be considered jointly, and for agreed actions to be recorded. They also enable HQIP to share examples of best practice and disseminate important information and updates.

Contract extensions

Most usually, NCAPOP contracts are awarded for an initial three year period with a possible further two year period agreed during the third year, subject to funder agreement and satisfactory delivery by the provider.

Publishing NCAPOP reports

Before NCAPOP reports are published, HQIP is required to co-ordinate a review process with the funding bodies and the Independent Advisory Group (IAG) if applicable.

This process represents due diligence and ensures there is appropriate assurance and constructive challenge of the report and its findings. This helps to ensures reports can support service providers, service users, clinicians, regulators, and commissioners to drive quality improvement in patient care and outcomes.

During the review stage, HQIP or the funding bodies may seek further clarification or information from the provider project team. Once no further clarifications are required, the reports can proceed to publication.

HQIP works with each audit provider to ensure that collected, validated and analysed data is reported at the earliest possible opportunity. However, there are two main factors which can affect publishing data:

• The most significant factor is access to essential data from other sources that complement the audit data to enable meaningful outputs to be produced, and the time required to satisfy the information governance approvals processes. HQIP proactively engages with all relevant data controllers, at a variety of levels, through frequent meetings to make this process as streamlined as possible.
• Where delays result from the actions of one of our project providers, we address this through pro-active contract management.

All NCAPOP reports are published on the audit provider’s and HQIP’s websites. HQIP publishes a nine-month schedule of the planned future publications: https://www.hqip.org.uk/ncapop-9-month-publication-schedule/.

HQIP has been working with audit providers on the dual themes of real time versus retrospective results. To produce reliable results there needs to be agreement by all that the techniques and collections are beyond reproach.

The NCAPOP programme has been working towards successfully producing timely data with a suitably assured reliability. For example, the Hip Fracture registry has moved successfully to give near-to-real-time data with an assured process and we see this as a model we wish other audit providers to adopt. The National Institute for Cardiovascular Outcomes research (NICOR) – the host organisation for the Myocardial Ischaemia (MINAP) audit- and the Paediatric Intensive Care Audit Network (PICANet) both responded to the 2020 Coronavirus crisis. PICANet is producing, currently, real time data to track current events. This may well be the model that is pursued going forward.

Project closure is a standardised formal process, made up of administrative closure, critical analysis, and contract closure. The aim of this process is to ensure that the project has achieved its contract deliverables, required outcomes, information governance responsibilities and met the expectations of its stakeholders.