The Getting It Right First Time (GIRFT) national report for endocrinology, authored by Professor John Wass (Oxford) and Mark Lansdown (Leeds), was recently published.

It adds to growing evidence that consolidating thyroid, parathyroid, adrenal and pituitary surgery can lower the rate of complications, improve outcomes from surgery and reduce the length of time patients stay in hospital, which is especially important in the context of the COVID-19 pandemic. The report examines endocrinology services across England and outlines opportunities to treat patients with many conditions sooner, by avoiding the duplication of diagnostic tests by GPs and secondary care teams, and ensuring patients are referred to clinicians with the appropriate experience.

It also looks at obesity services for patients in England, showing that, despite widespread demand, only 44% of hospitals offer a Tier 3 service which can manage complex obesity disease and help avoid harmful complications, such as type 2 diabetes, heart disease, a higher incidence of cancer and susceptibility to COVID-19 complications. The report recommends that Tier 3 services should be available countrywide.

Hospitals can improve outcomes for patients who need endocrine surgery by directing them to surgeons who perform the specialist operations more often, according to the report. 

It also finds that outpatient services can also be run more efficiently by making better use of pre-testing and remote appointments, while endocrine specialist nurses can significantly improve the efficient running of departments.

The report’s authors visited 127 NHS hospital trusts as part of their review of services and found that many hospitals were not correctly recording all endocrinology work taking place, meaning there are gaps in the data and funding for the specialty.

It sets out 17 recommendations including:

• Reducing unnecessarily long hospital stays, freeing up beds for other patients
• Reviewing triage and pre-investigation for outpatient appointments, to reduce unnecessary attendances at hospital and make the best use of patients’ time.
• Ensuring that patients with the most severe conditions are prioritised for treatment.
• Improving the data collected, especially for procedures which involve surgeons from different specialties.
• Optimising the running of endocrinology departments to release clinicians’ time to spend on patient care.

It also recognises the challenges facing the specialty, including growing demand and pressure on the workforce, and makes recommendations to invest in urgently-needed services to improve the quality and outcome of care for people with endocrine conditions.

Professor Wass said: “This review has provided an invaluable opportunity to look across the breadth of our specialty and ask searching questions about variations in current practice. One thing that was clear in our visits was that all the staff in endocrinology were working very hard, often in difficult circumstances, to provide excellent services to patients.

We want to ensure that patients are offered care at the most appropriate level and are dealt with by professionals – physicians and surgeons – with significant experience in treating their condition.”

You can read the full report on the FutureNHS platform (You will need to register to download it but access is granted quickly.)