Zoli Zambo, South West London CCG/ICS


South West London CCG/ICS is a member of the Evidence-based Interventions programme’s Demonstrator Community, helping to develop and test concepts as well as sharing our practical implementation experience with the national team.


At SWL, we have been working with our own version of the Evidence-based Interventions programme, locally called ECI, for several years. The key principle was to select patients who will clinically benefit, and for whom the risks associated with the interventions are outweighed. Currently, this is even more important, as thousands more patients are on the waiting list and prioritisation is necessary to ensure effective and appropriate treatment for those in the greatest need.


The presence of national EBI guidance aids our work in a few key ways:

National evidence

The evidence base is applicable regardless of where you are in the country. Collecting this data and doing it once/nationally saves time and resources for all concerned. We are pleased that our resident expert can contribute to the national Expert Advisory Group in this capacity.


There is more acceptance of the national criteria as the Royal Colleges, NICE, GIRFT and other national bodies are also consulted before implementation.  This lends the programme more credibility, which could not be achieved by SWL alone to this level.

Universal application

The England-wide criteria make it easier to implement locally. The national programme removes the need for hospitals to consider if the patient is to be treated under a specific CCG’s criteria. This should create a level playing field for providers who feared losing activity to those outside SWL previously because of the lesser rigor elsewhere.


Maximising scarce resource

Implementation of clinical thresholds requires in-depth local engagement and meaningful levers to ensure success. In recent years SWL used administrative measures supported by contractual penalties for persistent non-compliance. Those levers are no longer available since early 2020 and we are not expecting to rely on them going forward as the SWL ICS. Instead, we are focusing on quality and safety measures with the concept of clinical stewardship.


Rather than threatening with contractual penalties, we are aiming to engage frontline teams more and develop processes and tools to enable them to follow the clinical thresholds. Being part of the Demonstrator Community already gives us access to the core national team as well as to our peers engaged elsewhere, which is invaluable. In addition, in our local engagement programmes we involved members of the national EBI team so they can directly explain the programme or specific clinical thresholds and the evidence base. They also have the opportunity to hear from local front-line teams.


Tools developed nationally such as the activity benchmarking tool or patient leaflets also empower clinical teams. Alone, we would not have the resources required to create these.  The former can provide retrospective data for performance and peer reviews, while the latter can be used prospectively in consultation with patients.


Developing and implementing clinical thresholds requires significant resource and we often face obstacles and challenges. Overall, being part of the Demonstrator Community and liaising with the national team makes it significantly easier to do. In a time of disruption, with major legislative changes and ongoing challenges posed by Covid-19, this support is needed more than ever.