What is the Evidence-Based Interventions programme and who has been involved?

The Evidence-Based Interventions programme uses the latest evidence to develop guidance that aims to reduce harm and unnecessary interventions, by ensuring interventions routinely available on the NHS are evidence-based and appropriate. It is a joint enterprise between national partners; The Academy of Medical Royal Colleges (AoMRC), NHS Clinical Commissioners (NHSCC), the National Institute for Health and Care Excellence (NICE) as well as NHS England and Improvement.

Who is on the Expert Advisory Committee?

The expert advisory committee is an independent, expert committee comprising clinicians, guideline producers, commissioners, patients and academics. It was established in 2019, to provide independent advice and guidance to the Evidence-Based Interventions programme (EBI) It is co-chaired by Professor Martin Marshall, chair of the Royal College of General Practitioners and Professor Sir Terence Stephenson, Chair of the Health Research Authority.

What is the EAC’s role?

The Expert Advisory Committee’s role is to provide expert advice to the Evidence Based Interventions programme. In particular to:

  • Recommend a list of interventions that are available on the NHS and which are proven to be inappropriate that should not be routinely commissioned or should only be commissioned in specific circumstances to reduce patient harm, unnecessary intervention and to free up clinical time
  • Draft clinical guidance based on rigorous evidence and balanced consensus amongst patients, clinicians and commissioners
  • Facilitate a public and system consultation on the guidance and incorporate feedback from the consultation to produce EBI guidance on specific interventions that should not be routinely commissioned and/or the criteria for when interventions should be commissioned
  • Maximise the implementation of evidence-based guidance to reduce unnecessary and inappropriate interventions
  • Supporting the EBI programme, including public engagement, as appropriate.
Who else is on the EAC?

Chair(s)

Professor Martin Marshall  – Co-Chair,  Chair of the Royal College of General Practitioners

Professor Sir Terence Stephenson – Co-Chair,  Chair of the Health Research Authority and Nuffield Professor of Child Health

Members

Professor Derek Alderson,  Former President of the Royal College of Surgeons of England, 2017-2020

Dr Paul Chrisp,  National Institute for Health and Care Excellence

Dr Sarah Clarke,  Royal College of Physicians

Professor Adam Elshaug,  University of Sydney

Pam Essler,  Patient representative

Dr Sarah Markham,  Patient representative

Dr Ash Paul,  Public Health Consultant

Dr Josephine Sauvage,  Clinical Commissioner

Catherine Thompson,  Clinical Commissioner

April Wareham,  Patient representative, Strategic Co-production Group, NHS England and NHS Improvement

Dr Tim Wilson,  Managing Director Oxford Centre for Triple Value Healthcare and Honorary Clinical Fellow University of Oxford

Professor Danny Keenan,  Healthcare Quality Improvement Partnership

 

What is the purpose of this engagement?

Clinical leadership drives the EBI programme, therefore the Expert Advisory Committee (EAC) are independently engaging on the proposals for the 31 interventions in the EBI guidance. The EAC is gathering the views and opinions of patients, the public, key stakeholders and other interested parties as well as providers and commissioners of these test, treatments and procedures from across health systems. The AoMRC is supporting the EAC by hosting the engagement.

What will the outputs from the Expert Advisory Committees engagement be?

The Expert Advisory Committee will analyse the views and comments collated during the engagement period. This analysis will be used to further refine the proposals in the EBI guidance which will form the Expert Advisory Committees recommendations to the partners of the Evidence-Based Interventions programme.

What is the impact of Covid-19 on this programme?

The impact of COVID-19 on the NHS has reinforced the importance of the Evidence-based Interventions programme. The necessary pause in elective care work to deal with COVID-19 pressures has resulted in increased waiting lists for many procedures. As treatments are rescheduled, it is critical that clinicians’ time is freed from providing inappropriate care to focus on providing effective care for those who need it. This is directly in line with the aims of the Evidence-based interventions progamme.

Who selected the interventions and how?

The independent Expert Advisory Committee was commissioned by the Evidence-Based Interventions programme to develop an approach to select interventions and agree guidance. The Committee initially compiled a long list of interventions with no or limited clinical effectiveness, based on clinical evidence and research including NICE guidelines, Choosing Wisely recommendations and academic studies. It prioritised those interventions based on an established selection criteria and on the NHS’s ability to implement the changes quickly and on a large scale. It looked across surgical interventions and diagnostics, where there was high variability in the application of clinical guidelines. It also worked with the relevant Royal Colleges, specialist societies and clinicians and some patients to refine the list, ensuring there was clinical consensus and support.

How can people contribute to the engagement?

There are a number of ways you can contribute to the engagement:

  • Via the following link to complete the online questionnaire:

https://www.aomrc.org.uk/ebi/eb

  • Submitting an email response to: EBI@aomrc.org.uk
  • Joining one or all of the following engagement webinars to share your views:
    • 4 August – clinical focus
    • 11 August – clinical focus
    • 18 August – clinical focus
    • 19 August – data focus

In addition we are holding three patient focused workshops that are being led by the Patients Association.

The tests, treatments and procedures included in wave two EBI guidance

The Expert Advisory Committee has produced draft guidance on the following two interventions that should no longer be routinely commissioned or offered because they do not work or have been superseded by a safer alternative. However, on those rare circumstances where they may be appropriate, they can be offered if accompanied by a successful Individual Funding Request:

  • Exercise ECG for screening for coronary heart disease
  • Helmet therapy in the treatment of positional plagiocephaly in children

A further 29 interventions are included in the guidance that should only be commissioned or offered when specific clinical criteria are met (as they have only been shown to be appropriate in certain circumstances):

  • Diagnostic coronary angiography for low risk, stable chest pain
  • Repair of minimally symptomatic inguinal hernia
  • Surgical intervention for chronic sinusitis
  • Removal of adenoids
  • Arthroscopic surgery for meniscal tears
  • Troponin test
  • Surgical removal of kidney stones
  • Cystoscopy for men with uncomplicated lower urinary tract symptoms
  • Surgical intervention for benign prostatic hyperplasia
  • Discectomy
  • Radiofrequency facet joint denervation
  • Exercise ECG for screening for coronary heart disease
  • Upper GI endoscopy
  • Appropriate colonoscopy
  • Repeat Colonoscopy
  • ERCP in acute gallstone pancreatitis without cholangitis
  • Cholecystectomy
  • Appendicectomy without confirmation of appendicitis
  • Low back pain imaging
  • Knee MRI when symptoms are suggestive of osteoarthritis
  • Knee MRI for suspected meniscal tears
  • Vertebroplasty for painful osteoporotic vertebral fractures
  • Imaging for shoulder pain
  • MRI scan of the hip for arthritis
  • Fusion surgery for mechanical axial low back pain
  • Helmet therapy for treatment of positional plagiocephaly/ brachycephaly in children
  • Pre-operative chest x-ray
  • Pre-operative ECG
  • Prostate-specific antigen (PSA) test
  • Liver function, creatinine kinase and lipid level tests – (Lipid lowering therapy)
  • Blood transfusion
Is the intention to stop offering these interventions?

No. They will still be available when they are appropriate.

Of the list of 31 interventions, there are two Category 1 interventions (exercise ECG for screening for coronary heart disease and helmet therapy for treatment of position plagiocephaly/ brachycephaly in children) which should not be routinely offered as they are proven not to work in the vast majority of cases. However, we recognise that these interventions may not be suitable for IFRs. The clinician and patient should therefore discuss the benefits and risks before any decision on care is made.

The remaining 29 procedures will only be offered by the NHS in line with the evidence-based criteria detailed in the guidance.

General questions

Is this rationing?

No. The aim of the programme is to:

  • Reduce avoidable harm to patients. With clinical interventions, the risk of complications can never be entirely eliminated. Weighing the risks and benefits of appropriate treatments should be co-produced with patients. Patients should have the opportunity discuss the risks, benefits, alternatives and what will happen if they do nothing with their doctor when deciding what is right for them.
  • Save precious professional time. When the NHS is severely short of staff, professionals should only offer appropriate and effective treatment to patients. If resources are used on treatments that are not appropriate, fewer resources can be allocated to tests, treatments and procedures that are often more effective or deliver better outcomes for patients.

Maximise value and avoid waste. Inappropriate care is poor value for the taxpayer. Resources should be focused on effective and appropriate NHS services.

  • Help clinicians maintain their professional practice and keep up to date with the changing evidence base and best practice.
  • Drive innovation and to accelerate the adoption of new and proven innovations, the NHS should reduce the number of inappropriate interventions. This allows innovation in prescribing and technology to improve patients’ ability to self-care and live with long term conditions.
  • Reduce unwarranted variation. The data shows that there are wide disparities between the number of procedures carried out in different regions of the country. In many cases there is not reasonable or rational explanation for this other than differences in medical practice.

It’s important to note that the resources, such as time and money saved will be allocated in other types of care that are proven to be effective. This will help the NHS restore services and recover from the impact of Covid-19.

I have a query about the evidence used to substantiate the guidance, how can I share this?

Share your information and any further evidence with us as part of the engagement. All views, opinions and evidence will be reviewed as part of the ongoing development of the guidance throughout the engagement. All queries should be sent to: EBI@aomrc.org.uk

Is the data you are using robust?

We have worked closely with clinicians, commissioners, our demonstrator community – comprising 17 CCGs and STPs – and coding experts to review and refine the data and codes to ensure they are robust. However, in some cases there are limitations to the quality and availability of data. As a result, the 31 interventions have been grouped as follows:

(A) Those interventions for which data are available and sufficient to determine volume and variation, and establish goals using the same methodology as used in the initial list of 17 interventions. There are 13 interventions in this category;

(B) Those interventions for which data are available to determine volume and variation, but for which further work is required to establish goals, such as linking with additional datasets such as Diagnostic Imaging Dataset. There are 12 interventions in this category; and

(C) Those interventions for which data are not currently available; but for which further datasets are being explored to assess their accessibility and quality. There are six interventions in this category.

I have a query about the data and/or coding, how can I raise this?

Please share your insight and advise on the data and coding as part of the engagement. All views, advice and data will be reviewed as part of the ongoing development of the guidance throughout the engagement. All queries should be sent to: EBI@aomrc.org.uk

I would like to join a webinar - how do I do this?

For further information about taking part in a webinar please follow this link

Can virtual engagement replace face-to-face consultation?

We must also ensure the safety of all NHS staff and patients and reduce the risk of exposure to Coronavirus whenever possible. For this reason, Government guidelines restrict what we can do when engaging with people whose views we want to hear.  Using virtual engagement through online platforms and channels means we can still reach out to a wide audience. It also means people are not restricted from contributing by travel or carer responsibilities.