Detection and management of outliers for National Clinical Audits

Guidance | Published: 12 May 2017

This guidance updates the 2011 Department of Health guidance ‘Detection and Management of Outliers for National Clinical Audits. It explains the expectations required of national clinical audit providers and healthcare provider organisations in relation to the identification of outliers by national clinical audits. We have consulted with NHS England, the National Advisory Group on Clinical Audit and Enquiries (NAGCAE), NHS Improvement and the Care Quality Commission as part of our revision of the guidance.

The primary changes compared to the 2011 guidance are:

  • NCA providers to notify the Care Quality Commission of any confirmed alarm level outliers identified by the audit
  • NCA providers to notify the Care Quality Commission and NHS Improvement of any healthcare provider organisations that fail to respond appropriately (as described by the guidance) to notification of confirmed alarm level outlier status

HQIP recognises that both national clinical audits and healthcare provider organisations will need time to adjust their processes and activities to accommodate the changes outlined in the revised guidance. As a result, HQIP have agreed a delayed implementation period with NHS England and CQC. The transition will be timed around cohort data collection end points. Any audits for which the cohort data collection period is after the 1st November 2017 will be subjected to the new guidance. The 2011 guidance will remain applicable for any audit data sets for which the cohort data collection period ends before the 1st November.

In November 2018, guidance for outliers in Wales was added and is available to download below.

Don’t miss out. Sign up to be notified when this resource is updated and to receive updates about other related quality improvement resources, events and news from HQIP. Or you can  .


By continuing you agree to receive emails with updates and other information from HQIP and you are confirming you are over the age of 13.

Please read our privacy policy to understand how HQIP uses the information you provide, your use of HQIP’s website and your interaction with the marketing emails to improve the relevance of the communications we send you. You can unsubscribe at any time.

I have read and agree with the contents of the privacy policy.

Detection and management of outliers for National Clinical Audits