Statement concerning recording of clinician GMC number within the NELA dataset

Please find below a statement from the NELA Project Team. We are issuing this statement in response to concerns raised about collecting GMC number within the NELA dataset in order to clarify the reasons for doing so.

We are aware that there is some debate about the collection of clinician GMC number within the NELA dataset, and how it might be used, not least because of the media coverage after the publication of consultant-level outcomes. We wish to clarify the rationale for collecting GMC number as part of the NELA dataset and the purpose for which the GMC number will be used.

The aim of NELA is to improve the quality of care of patients undergoing emergency
laparotomy. This will be achieved by measuring both processes of care and the outcomes of emergency laparotomy surgery in hospitals within the NHS in England and Wales. This will allow us to identify hospitals where clinical practice may be improved, and hospitals where best practice exists so that this can be disseminated across the NHS. By collecting GMC number, NELA will be able to evaluate various important care processes.

First, it will allow the Audit to see if the operating surgeon is the same as the surgeon
making the decision for surgery, and investigate the effects of handing over care. Different models of care exist that reflect local needs, and this will allow us to identify hospitals with best practice for these different models.

Second, it will also allow us to take account of the numbers of individual consultants within a hospital performing emergency laparotomy, and their specialty. This will allow us to distinguish between hospitals where few clinicians deliver most of the emergency laparotomy service and other hospitals where a large number of different clinicians are involved in the delivery of care, suggesting that individual practitioners may have low volumes. Furthermore, there is evidence that subspecialty has an impact on outcome in certain pathologies and collecting the GMC number will allow us to explore this.

Collecting the GMC number will also benefit clinicians directly because it will allow them to use their own data for appraisal and revalidation purposes.

NELA does not intend to publish surgical outcomes at an individual clinician level for this audit. This is primarily due to the fact that emergency care of this nature involves both a patient population and level of operative complexity that cannot currently be adequately taken into account by risk adjustment models or data stratification applied at a clinician level.

The current contract that exists between the Healthcare Quality Improvement Partnership and the Royal College of Anaesthetists is to produce outcome information only at hospital level. NHS England may decide that patients should have access to clinician-level quality measures on emergency laparotomy in future. It already has the option of producing this information using routine data such as Hospital Episode Statistics (HES) data. In addition, the Health and Social Care Information Centre (HSCIC) has initiated a pilot programme to secure changes to the HES Data Set to enable the recording of operating surgeon and anaesthetist;
the pilot will run in the first 6 months of 2014. However there are some concerns over the accuracy of the HES coding, reflected in calls for clinicians to have greater involvement in coding operative procedures. NELA is not unique in collecting GMC number; several other national clinical audits already collect clinicians' GMC numbers. By collecting GMC number, NELA will be in a stronger position to help clinicians improve outcomes by improving the quality of care delivered to patients.

We recognise the importance of this issue and will continue to monitor the situation and make adjustments as necessary.