In the drive to improve patient care, accreditation constitutes an integral tool in raising the quality and outcomes of clinical services. The Royal College of Physicians (RCP) runs a number of accreditation schemes in various disciplines, and has recently launched the Improving Quality in Allergy Services (IQAS) and Quality in Primary Immunodeficiency Services (QPIDS) schemes, which accredit allergy and primary immunodeficiency services, respectively. The launch of these schemes marks real progress in the drive for patient-focused, standardised and quality care for patients with allergies and immunodeficiency.
The need for an allergy accreditation scheme was highlighted in the RCP working party report Allergy services: still not meeting the unmet need.1 IQAS was launched initially as a registration scheme, consisting of a ‘light touch’ self-assessment process, which was aimed at preparing the specialty for the development of accreditation standards prior to the establishment of the current accreditation scheme. IQAS is run with expert guidance from the Joint Committee on Immunology and Allergy (JCIA).
The QPIDS accreditation scheme was originally established by the UK Primary Immunodeficiency Network (UKPIN) following the findings of a Department of Health-sponsored national audit of primary immunodeficiency services.2 By 2015, 15 inspection visits had been undertaken and there were ten accredited centres (some centres had gone through the accreditation cycle more than once). The requirement for accreditation for commissioning of specialist services and better awareness of the scheme led to increased demand, and as a result, UKPIN approached the RCP to adopt the accreditation scheme. The RCP has adapted the process to bring it in line with its methodology and has improved organisational aspects including governance and quality assurance.
Accreditation is a cyclical process of self-assessment, quality improvement and peer assessment. Services begin in stage one, where they perform a gap analysis against the accreditation standards and identify areas requiring improvement. Once a service has made these improvements and uploaded evidence to show adherence to the standards, they move to stage two, where peer assessors remotely assess the evidence presented and perform a site assessment.
If services are found to meet the standards they are accredited for five years, while services which do not meet one or more of the standards are provided with a comprehensive report detailing the areas which require improvement. Once services have uploaded evidence of compliance in these areas, they are granted accreditation. Once accredited, services undertake an annual renewal assessment to demonstrate their continued compliance with the standards, and after five years undergo a full reaccreditation assessment as per stage two. An annual fee is paid by services to cover the costs of the support services and assessment process.
Each scheme’s standards have been developed after extensive consultation with the respective specialties and related professional bodies, including the JCIA, British Society for Allergy and Clinical Immunology (BSACI), UKPIN and the BSI. The standards cover all aspects of a clinical service and are organised into six domains for each scheme:
|Domain 1: Patient experience||Domain A: Organisation and administration|
|Domain 2: Service structure||Domain B: Staffing|
|Domain 3: Facilities||Domain C: Facilities|
|Domain 4: Quality and safety||Domain D: Clinical care|
|Domain 5: Audit and research||Domain E: Home therapy|
|Domain 6: Training and development||Domain F: Audit, education & management|
Benefits of the schemes
The primary objective of accreditation is to improve the quality, safety and outcomes of healthcare. This is achieved through:
- Recognising good practice so it may be furthered and shared
- Identifying sub-optimal practice so it may be improved
- Standardising care within services and between services
- Identifying the staff and resources required to deliver high quality care
- Sharing documents, policies and processes between services
- Involving patient representatives and patient groups in the management of services
- Establishing a culture of continuous quality improvement
- Providing external validation of service quality
The Care Quality Commission’s (CQC) chief inspector of hospitals has acknowledged that accreditation has a key role in hospital inspections, recognising the value of such schemes as information sources. Additionally, the Any Qualified Provider (AQP) and Best Practice Tariff programmes recognise the accreditation schemes run by the RCP as the standard of quality for commissioning of services.
“The launch of these schemes marks real progress in the drive for patient-focused, standardised and quality care for patients with allergies and immunodeficiency.”
Furthermore, the NHS England service specifications for specialised immunology and allergy services state that ‘all centres should participate and actively work towards… accreditation’, and commitment to achieving accreditation is a prerequisite for commissioning of those specialist services receiving referrals from primary care for general and specialist care.
At time of writing there are 19 services registered with IQAS and 23 with QPIDS which are working towards the accreditation standards, and we hope other services to join by the end of the year. The next milestone for each scheme will be the first accredited service, with both schemes expecting the first services to be ready for accreditation soon. Services are encouraged to register as soon as possible to take advantage of the support services available, and BSI members in clinical services can get involved by working with their colleagues to prepare for accreditation.
Programme Manager – IQAS and QPIDS, Royal College of Physicians
M. T. Krishna
Consultant Allergist and Immunologist, Heart of England NHS Foundation Trust and Aston Medical School,
IQAS Clinical Lead, Royal College of Physicians
Consultant Immunologist, Plymouth Hospital NHS Trust
QPIDS Clinical Lead, Royal College of Physicians
1. Royal College of Physicians. 2010. Allergy services: still not meeting the unmet need. London: RCP.
2. Spickett & Chapel 1998. Report on the audit of patients with primary antibody deficiency in the United Kingdom 1993-1996. Newcastle upon Tyne Hospitals NHS Trust.