National Demand Optimisation Group (NDOG) Phase III Report and Phase IV re-focus on COVID-19 pandemic monitoring

The recent publication of the CMO’s annual report for 2020 – 2021: Recover, Restore, Renew highlighted the importance of tackling unwarranted variation in practice and outcomes. Progress made in the delivery of the Healthcare Science National Delivery Plan 2015–2020 around adopting principles of a Realistic Medicine approach led to the publication of the National Demand Optimisation Group (NDOG) Phase III Report on 24 March 2021.

As a Scottish Government commissioned group, the objective of the National Demand Optimisation Group (NDOG) is to reduce unwarranted variation in laboratory diagnostic testing, contributing to improved patient outcomes. The group has recently completed its third phase of work, albeit interrupted by the COVID-19 pandemic. Subsequent work (Phase IV) has now focused on providing lab workflow data during the pandemic and into the remobilisation phase that can act both as a direct measure of laboratory pressures and a surrogate metric for healthcare activity/gaps.

This Phase III report presents the refinement of the Atlas of Variation for Laboratory Diagnostics tests, extensive ongoing data collection and Quality Improvement initiatives within the diagnostic and primary care community.

As the NDOG programme moved into Phase IV in the new COVID-19 healthcare landscape, the programme has re-focused its scope to use lab workflow data to identify emerging gaps in NHS service provision and facilitate appropriate diagnostic test use going forwards. New pandemic monitoring dashboards are now being created that will allow health board level analysis and comparison of laboratory activity across a variety of test and specimen types.

This will allow:

*see addendum at the end of the Phase III report for current status of this work: Lab Activity as a Metric for Pandemic Healthcare Trends.

The pandemic has highlighted the importance of a collaborative approach which utilises combined experience and knowledge to achieve the best outcomes for our people. This approach also reduces variation in practice and outcomes, especially when faced with novel or complex challenges.

As Realistic Medicine is firmly embedded as a key enabler within the NHS Clinical Prioritisation, Remobilisation and Rehabilitation Frameworks, NHS Boards have been encouraged to utilise the Atlas of Variation in Diagnostics as a monitoring tool that tracks diagnostic activity during the pandemic and into recovery. This information is a direct surrogate metric for associated clinical activity and can be used to identify healthcare gaps, monitor recovery, and enable better informed prioritisation decisions.