Outlier management for National Clinical Audits

Updated 14/07/2020: outlier escalation guidance for England and Wales during the COVID-19 pandemic

HQIP has modified the outlier management notification stages for alarms (i.e. Table 1) for HQIP-commissioned audits operating in England and Wales in collaboration with NHS England/Improvement, the Care Quality Commission and Welsh Government.

For information about the standard outlier process, please see the pre-COVID-19 outlier management information below.

Previous 02/04/2020 (see section 10):

HQIP COVID-19 guidance to NCAPOP (audit and CORP) Providers


Outlier management can help to inform local quality improvement by targeting efforts and monitoring improvement or decline over time. All National Clinical Audits in the NCAPOP should:

1. Once established, undertake outlier analyses and notification for each national reporting cycle

2. Develop and follow a project-specific outlier policy which should be available publicly on their project webpage. This is normally based on the HQIP guidance (see below for England and Wales).

The following outlier guidance applies to:

  • Comparisons of healthcare providers (general practices, hospitals, trusts, clinical networks, but not individual practitioners[1]) using batches of data collected over an appropriate defined period (and not continuous monitoring); and
  • Both outcome and process measures of performance (referred to as ‘performance indicators’)

Building on successful examples of sharing ‘alert’ level data, HQIP has agreed to support extending ‘alert’ level data across all NCAPOP audits as appropriate. For further details please see the English guidance below (May 2020).

Current guidance for England

The following applies to any data from patient cohorts with a collection starting from 01/11/2017:

Current guidance for Wales

The following applies to any data from patient cohorts with a collection starting from 01/11/2018:

Previous guidance for England

The following was applied to data from patient cohorts with a collection starting before 01/11/2017:

Previous guidance for Wales

There was no previous guidance for Wales for data from patient cohorts with collection starting before 01/11/2018.

For further information, NCAPOP audits should consult the HQIP Provider Technical Manual.


[1] This is covered by the Clinical Outcomes Publication Technical Manual, HQIP, (2016)