In order to address a significant backlog for colonoscopies at the Royal United Hospital in Bath, the PCT included service redesign and clinical validation for colonoscopies in the practice based commissioning (PBC) plan.

GPs worked closely with secondary care consultants to develop a clinical validation process and redesign the pathway for referral to secondary care.

A waiting list of over 800 patients who were waiting more than nine months was reduced to around 70 who were waiting more than six weeks. This process took seven months with considerable support from GPs, practices and secondary care.

Approximately half of the validated patients were removed from the list for either administrative or clinical reasons. Of the half who still required the procedure, 40% had their scope undertaken at a local treatment centre.

Results of the audit indicate that it would be best practice to audit all patients waiting after a period of time to ensure they still require a scope, and to avoid the dangers of unnecessary intervention. A system has been established of validation to ask GPs to confirm that the patient still requires a procedure after they have been on the list for six weeks. Initial work indicates that 15% can be removed with clinical validation 6-8 weeks after referral for a scope.