Community-Based Surgery Audit

National Pilot phase has been completed

The pilot phase of the Community-Based Surgery Audit (CBSA) ran from 2013 to March 2015, at the end of which it had over 150 users and over 6000 surgical procedures recorded.

From this pilot phase the data from all the users was presented as a poster at the 2014 RCGP Annual Conference, and was awarded a Highly Commended rosette in the ‘Audit’ category – the most popular category with over 100 poster submissions.

The final report for the CBSA has been written and can be read here.

A paper based on the ground-breaking findings was submitted to the  British Journal of General Practice. We are pleased to announce it has been accepted for publication and you can view it in full here.

CBSA

The results have shown that contrary to much published evidence the GPs involved so far in the CBSA have demonstrated the following:
High levels of diagnostic accuracy: 95% of all BCCs were correctly diagnosed clinically
High levels of histological analysis:  89% of all lesions were sent to histology

In addition:
High quality surgery: 93% of all malignancies were completely excised
Reported complication: only 2% overall (and proven infection rates of only 0.4% overall)
Accessible surgery: 73% of all surgery within 8 weeks of referral

The RCGP would like to encourage all GPs who operate in the community to register and use the tool and help make this the largest, most comprehensive dataset of its kind. To do this, please click here for more information and to register. The CBSA is also an example of outstanding practice for CQC inspectors (see links below).

The pilot phase newsletters from Dr Jonathan Botting, Clinical Lead for this project, are below:

Introduction

The Community-Based Surgery Audit was developed by the RCGP's Clinical Innovation and Research Centre (CIRC) in collaboration with the Health and Social Care Information Centre (HSCIC). It was established to enable practitioners of community-based surgery to collect evidence on the quality of the surgery they undertake.

It aimed to:

  • build a mechanism that measures the quality and quantity of community-based surgery undertaken in the UK
  • support practitioners of surgery in community settings in monitoring and improving the quality of the service they provide by providing feedback on their practice and results and allowing comparison with their peers
  • allow individual practitioners to collect data to support re-accreditation, appraisal, revalidation and local contracting
  • allow high-level analysis and reporting of data submitted by all participating practitioners to give an overview of community-based surgery practice

What did it measure?

The audit is concerned with operative procedures on patients aged 18 years or older, carried out under local anaesthesia in a community setting and likely to involve (with the exception of toenail surgery) the removal of material for histological analysis. This encompasses all dermatological surgery (removal of skin lesions), including some more technically challenging excisions including flaps and grafts under local anaesthesia and toenail surgery. It does not currently include vasectomy, carpal tunnel, trigger finger or ganglion surgery.

The dataset includes information on patient details, clinical details of lesions treated, surgery undertaken, results of histological analysis and the occurrence of any complications. It is designed to allow assessment of the timelines of treatment, accuracy in diagnosis, surgical technique, patient outcomes and other indicators of the quality of clinical practice. Most uniquely, the CBSA tool allows clinicians to compare these statistics to their peers’ data once they’ve logged three months of data. This unique reporting system is similar in principle to that found throughout secondary care to allow units to benchmark their quality and its existence is well overdue in primary care.  

The audit system is based on a secure web-based portal through which participants submit information on individual cases they treated. The data is held on secure servers operated by HSCIC.

Pilot summary

The design of the audit included GPs both with and without specialist interests, dermatologists, dermatological surgeons, statisticians and systems designers. Within the steering group we had representation from the British Association of Dermatologists, the British Society of Dermatological Surgery, the British Medial Association, the Primary Care Dermatology Society and the Association of Surgeons in Primary Care.

The pilot began in 2013 with a limited release phase during which a number of practitioners who had expressed an interest in early involvement, the Clinicians Working Group, used and tested the system. The only extra work involved for contributors was the data entry and this process was made as easy, quick and as user-friendly as possible with data security maintained to the highest level. The system was updated based on their experience and feedback and the audit then progressed to a national pilot. The data collection for the report ran from 18/4/13 until 31/3/15.  All practitioners of community-based surgery, regardless of how much surgery they undertake, are now encouraged to participate both for their own benefit and to help build up a national record of community based surgery.

Additional resources 

Minor Surgery resources

HSCIC

Vasectomy and Carpal Tunnel audits: see the APSPC website for more details.

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