The commissioning process of national clinical audit programmes

How does HQIP commission projects?

HQIP is responsible for managing the full commissioning cycle for the NCAPOP programme. This involves:

  • managing the procurement of new projects
  • managing the procurement of those projects selected for re-commissioning
  • contract management of the team or organisations contracted to deliver those projects

There are a number of defined stages in the commissioning process:

  1. Topic prioritisation and selection
  2. Specification development
  3. Invitation to tender
  4. Tender evaluation and moderation
  5. Contracting and contract management
  6. End of project and close down
1. Prioritisation and selection

Topic prioritisation is the term given to the process that NHS England undertakes – with advice from the National Quality Board NCAPOP Partners Subgroup that includes HQIP and the National Quality Improvement (including Clinical Audit) Network (NQICAN)– to systematically prioritise which clinical care areas are covered by the NCAPOP.

Projects are selected for inclusion in the NCAPOP based upon on a number of factors which include:

  • Alignment with overall NHS England and Welsh Government priorities
  • Impact and value for money
  • Need, including care quality and outcomes and variation in care quality and outcomes
  • Professional and patient/carer support
  • Alignment with other national activities

Every project within the NCAPOP has been established to address a clinical area (or areas) where healthcare improvement is required, and the common aim of each project is to have a positive impact on patient care.

2. Specification development

HQIP holds Specification Development Meetings (SDMs) to support the development of high quality service specifications against which tender returns can be invited.

An SDM is divided into two parts:

  • the first part where the discussion centres on the potential improvement focus and key features for the proposed future programme as well as the benefits and risks associated with those features. This typically includes representation from: the funding body; key professional stakeholders and those who have specific expertise related to the programme; patient/carer/parent voice partners; audit professionals and potential bidders for the project.
  • The second part of the SDM involves HQIP, public and patient representation, funders and their advisors. The key features of the programme specification are agreed. Part 2 of the meeting marks the start of the procurement phase for the project and potential bidders or those with conflict of interest are excluded.
3. Invitation to tender

Once a specification has been developed, HQIP commences a formal tendering process and welcomes tenders from potential bidders. All contract opportunities are published on HQIP’s website as well as those publications and websites required by procurement legislation (currently covered by EU legislation).

4. Tender evaluation and moderation

Tenders received are reviewed and scored against the criteria that were outlined in the formal invitation to tender. The reviewing panel usually includes representatives from:

  • HQIP
  • the funding bodies (such as the NHS England National Clinical Director),
  • the clinical specialty
  • HQIP’s Commissioning Support Group (CSG) which include individuals from the NCAPOP provider community as well as individuals with roles in local NHS healthcare delivery and governance
  • Representation of the patient/carer/parent perspective

HQIP contracts usually run for between 3 and 5 years. If it is agreed that an audit topic will be re-commissioned, and a seamless continuation of the project is required, HQIP will aim to begin the retender process typically 12 months prior to the end of the current contract.

5. Contracting and contract management

Once a contract has been awarded, appropriate governance arrangements and structures are put in place by NCAPOP providers to ensure successful delivery of the project and to safeguard public funding. The provider is also responsible for ensuring that it, and any other data processor contracted as part of the project, are compliant with all data protection laws and information governance requirements.

Contract review meetings

HQIP organises and chairs regular contract review meetings (CRM) with each provider to monitor performance on behalf of the funders (e.g. NHS England, Welsh Government, etc.), against the following requirements:

  • Contract
  • Deliverables
  • Resources (for example finances)

As well as documenting and monitoring delivery progress, the contract review meetings present an opportunity to identify risks, issues, and challenges which can be considered jointly, and for agreed actions to be recorded. They also enable HQIP to share examples of best practice and disseminate important information and updates.

Contract extensions

Most usually, NCAPOP contracts are awarded for an initial three year period with a possible further two year period agreed during the third year, subject to funder agreement and satisfactory delivery by the provider.

Publishing NCAPOP reports

Before NCAPOP reports are published, HQIP is required to co-ordinate a review process with the funding bodies and the Independent Advisory Group (IAG) if applicable.

This process represents due diligence and ensures there is appropriate assurance and constructive challenge of the report and its findings. This helps to ensures reports can support service providers, service users, clinicians, regulators, and commissioners to drive quality improvement in patient care and outcomes.

During the review stage, HQIP or the funding bodies may seek further clarification or information from the provider project team. Once no further clarifications are required, the reports can proceed to publication.

HQIP works with each audit provider to ensure that collected, validated and analysed data is reported at the earliest possible opportunity. However, there are two main factors which can affect publishing data:

  • The most significant factor is access to essential data from other sources that complement the audit data to enable meaningful outputs to be produced, and the time required to satisfy the information governance approvals processes. HQIP proactively engages with all relevant data controllers, at a variety of levels, through frequent meetings to make this process as streamlined as possible.
  • Where delays result from the actions of one of our project providers, we address this through pro-active contract management.

All NCAPOP reports are published on the audit provider’s and HQIP’s websites. HQIP publishes a nine-month schedule of the planned future publications: https://www.hqip.org.uk/ncapop-9-month-publication-schedule/.

HQIP has been working with audit providers on the dual themes of real time versus retrospective results. To produce reliable results there needs to be agreement by all that the techniques and collections are beyond reproach.

The NCAPOP programme has been working towards successfully producing timely data with a suitably assured reliability. For example, the Hip Fracture registry has moved successfully to give near-to-real-time data with an assured process and we see this as a model we wish other audit providers to adopt. The National Institute for Cardiovascular Outcomes research (NICOR) – the host organisation for the Myocardial Ischaemia (MINAP) audit- and the Paediatric Intensive Care Audit Network (PICANet) both responded to the 2020 Coronavirus crisis. PICANet is producing, currently, real time data to track current events. This may well be the model that is pursued going forward.

6. End of contract and project closure

Project closure is a standardised formal process, made up of administrative closure, critical analysis, and contract closure. The aim of this process is to ensure that the project has achieved its contract deliverables, required outcomes, information governance responsibilities and met the expectations of its stakeholders.

What happens to NCAPOP data?

The NCAPOP programme provides a national source of reliable data to answer questions about standards of care, highlight areas of concerns and allow comparative measurements of healthcare quality.

On a local level, NCAPOP audits provide local trusts with individual benchmarked reports on their compliance and performance, feeding back comparative findings to help identify where improvements should be made.

Patients, users of services and the public can use NCAPOP data to find out how their local NHS services are performing. This can help them to make informed decisions about their care.

National audit data informs the UK’s government and devolved administrations’ approach to health policy. It gives health funding and commissioning bodies an evidence base for making decisions and reducing variation in care standards, as well as informing the commissioning of specialist services.

It also supports the regulatory system in the UK and Wales with the Care Quality Commission using national audit data as part of its quality inspections.

Data collected by NCAPOP projects that is not anonymous is not placed in the public domain. However, HQIP can share this data with specified individuals for a number of purposes including research, service evaluation, and audit, if certain conditions and safeguards are met.

The burden of data collection placed upon local NHS trusts as part of its commissioning activities

As part of their NHS Standard Contract, all NHS trusts providing the relevant clinical service for each project are required to participate in NCAPOP projects including the collection and submission of data and review of the project reports. Trusts are required to publish a Quality Account each year on the quality of the services that they provide. All NCAPOP projects are included on the list of project activity that they are asked to report against.

HQIP is conscious that all projects within the NCAPOP place a burden on those who are responsible for collecting and submitting data. This burden is explicitly considered at each stage of commissioning; it is one of the main considerations during the specification development phase.

  • HQIP works with the providers of each NCAPOP project to develop and review their datasets to ensure that the minimum dataset is required to meet the needs of the audit.
  • Where data are routinely collected by other organisations, HQIP supports and facilitates data sharing and linkage activities.

HQIP maintains a directory of useful information on all known national clinical audits as well as other quality improvement projects. This includes contact details for the audits, links to recent publications, planned data collection periods and inclusion and exclusion criteria.

HQIP also supports the National Quality Improvement and Clinical Audit Network (NQICAN) which represents NHS staff who work on clinical audit and quality improvement projects. NQICAN members attend all HQIP SDMs. Further information about NQICAN is available at: http://www.nqican.org.uk/.