The reconfiguration of clinical services report provides new insights into the drivers of reconfiguration and the underpinning evidence. It builds on a major analysis, commissioned by the National Institute for Health Research (NIHR), of reviews of service reconfigurations conducted by the National Clinical Advisory Team (NCAT).
This page summarises the report's findings on the reconfiguration of specialist vascular surgery.
Proposals reviewed by NCAT
The proposals reviewed by NCAT involved the centralisation of specialist vascular surgical services alongside the creation of vascular clinical networks and the designation of vascular surgery and screening centres.
Key drivers of specialist vascular surgery reconfiguration
National policy and quality were the primary drivers of this type of reconfiguration.
Context and relevant policy
- In 2013, around 21,000 patients had an elective repair of an abdominal aortic aneurysm (AAA) and 16,000 patients had carotid endarterectomy.
- As a specialist service, since April 2013, vascular services have been commissioned by NHS England. The standard contract for specialised services draws heavily on guidance from the Vascular Society for Great Britain and Ireland and NCEPOD, as well as available evidence, and includes the recommendations summarised below. The contract also stipulates target outcomes, access times and minimum volumes for vascular surgery centres.
The current evidence base
There is good evidence to support the concentration of specialist vascular services in centres serving larger populations (NHS England contract suggests 800,000) with surgeons doing minimum volumes of activity and the centres having the necessary critical care, radiological and surgical support services.
Telemedicine can be used to safely assess patients with vascular problems in more remote locations, avoiding lengthy travel to outpatient consultations.
Relevant college and other guidance
The Vascular Society for Great Britain and Ireland has used the available evidence to underpin its professional guidance which is reflected in the NHS England contract:
‘A minimum population of 800,000 is considered necessary for an AAA screening programme and is often considered the minimum population required for a centralised vascular service. This is based on the number of patients needed to provide a comprehensive emergency service, maintain competence among vascular specialists and nursing staff; the most efficient use of specialist equipment, staff and facilities, and the improvement in patient outcome that is associated with increasing caseload.’
NHS England 2013b, p 2
‘Each surgeon will need to have an appropriate arterial workload (eg, in the region of 10 AAA emergency and elective procedures per surgeon per year and commensurate numbers of lower limb and carotid procedures), which will necessitate an appropriate catchment area to generate sufficient case volume.’
NHS England 2013b, p 8