Under the auspices of the Healthcare Science National Delivery Plan (NDP), the Scottish Government funded the establishment of a National Demand Optimisation Group (DOG) to review the third deliverable of the NDP, which states:
NHS Board Healthcare Science Leads will work with stakeholders to develop local improvement plans to reduce unnecessary testing across primary and secondary care. This would free up capacity to address rising demand and deliver testing that positively affects the patient pathway, supports primary care preventative measures and reduces hospital referrals and admissions.
Further details can be found at the Scottish Government website.
Phase I of Demand Optimisation began in 2016 with a number of aims. An extensive Phase I Report was published in January 2017, detailing a comprehensive overview of demand optimisation and demand management activity and structures across NHS Scotland. The main recommendations of the report clearly demonstrated that further work was required to continue to drive this forward. In addition, although diagnostic networks directed their Steering Groups to progress implementation of the report, and local arrangements put in place in some NHS Board areas, there was no overarching, cohesive national plan to progress this work.
The work of Phase II developed a Diagnostic Atlas of Variation (AoV). The identification of good practice for potential roll-out along with the inception of a National Atlas of Variation for laboratory testing which allowed the development of future approaches that informed more rational testing while ensuring equal access to new and novel testing. Phase II report outlines activity which continued to develop the themes from phase I. This includes the full development of an Atlas of Variation (AoV) for laboratory test requesting covering multiple disciplines from the whole of Scotland.
The key focus of Phase III was to maintain the momentum and success of the two preceding phases, and to pilot the Atlas with referring clinicians. Phase III also focused on sustaining current quality improvement initiatives, while delivering and monitoring new QI proposals and their progress. Engaging with referring clinicians to continue to improve the Atlas of Variation and promoting its capabilities within the GP community. Phase III report highlights the outcomes of the programme of work.
Throughout Phase IV the Scottish National Demand Optimisation Group (NDOG) continued to produce invaluable reports and recommendations that highlighted the proactive and collaborative measures to reduce unwarranted variation in the delivery of healthcare in NHS Scotland. Phase IV report highlights the main outcomes, including the publication of the interactive recovery monitoring dashboards. Phase IV built on the existing principles of the first three phases, demonstrating the successful modification of well-established data collection and display methods to focus on more relevant testing trends occurring during the COVID-19 pandemic and into the recovery phase.
During Phase V, the NDOG continued to work collaboratively with a range of stakeholders to deliver key outcomes and outputs that would result in a reduction in unwarranted variation in diagnostic laboratory tests in primary care, throughout Scotland. Phase V report details the main outputs of the Phase V programme of work, including national rollout of the primary care Atlas of Variation (AoV) for diagnostic laboratory tests and associated education toolkit on 1 April 2022.