Guidance

Diabetic eye screening: KPI and standards data submission

Updated 7 June 2019

1. Timescales

Q1 (1 April to 30 June)

Time for sense checking and return: 1 September to 30 September

Q2 (1 July to 30 September)

Time for sense checking and return: 1 December to 31 December

Q3 (1 October to 31 December)

Time for sense checking and return: 1 March to 31 March

Q4 (1 January to 31 March)

Time for sense checking and return: 1 June to 30 June

2. KPI submission process

The steps in the submission process are:

1. When the data submission window opens, the local provider runs 3 programme performance reports from their system:

• for the reporting period current quarter
• for the 12 months ending in the reporting period current quarter (for example, for Q2 this would be 1 October 2019 to 30 September 2020) this is required because DE1 and other quarterly standards are counted over a rolling 12-month period
• for the quarter previous to the current quarter (not required for KPIs but needed to calculate standards that require a longer timeframe to be complete) ^{[footnote 1]}

1. The programme manager and clinical lead review the data prior to submission in accordance with any locally agreed arrangements.

2. The local provider emails the reports to the DES programme phe.desdata@nhs.net.

3. The NHS Diabetic Eye Screening (DES) Programme follows up any non-responders after 2 weeks of the submission window opening.

4. The NHS DES Programme sends the KPI numerators, denominators and percentages to the programme manager and clinical lead to review and sign off their individual figures. Commissioners should be made aware of the figures prior to sign off either by email or at programme board. The programme copies the KPIs to screening quality assurance service (SQAS) regional offices for information.

5. The local provider has 2 weeks to review and sign off the figures and raise any issues regarding the accuracy of the data. If no response is received within 2 weeks the programme accepts the data as accurate.

6. Concerns regarding data quality should be addressed to the DES programme at phe.desdata@nhs.net. Any concerns are resolved between supplier, local provider, SQAS (regions) and the DES programme as appropriate. Data quality issues can arise if:

• 2 successive KPIs from one provider have the same numerator and denominator
• the KPI figure is much higher or lower than previous quarters
• no data is submitted
• the file received contains no data

1. Once data quality issues are resolved, local providers run the performance reports again and send to the DES programme so that the changes are reflected in the extracted data.

2. The data is processed again by the DES programme and signed off with the programme manager and clinical lead. The DES programme then sends the final figures to the national KPI screening data and information manager on the last day of the submission window.

Only complete data is published. The DES programme shares KPI data with NHS England before publication. As DE3 is a small number KPI it is collected quarterly but only published annually.

3. Quarterly pathway standards report

Please note that extended screening intervals will be introduced in the future. There may be an impact on reporting during the implementation period. Further information will be provided as necessary.

The programme produces reports for each local provider for quarters 1 to 4 using the 3 performance reports submitted for the KPIs.

The data is extracted for the relevant time periods as per steps 1 to 4 above. However, the programme manager and clinical lead may wish to review the additional data fields contained in the programme performance report that will be used to calculate the pathway standards.

The steps in the production of the quarterly pathway standards report are as follows.

1. The programme uses the performance reports supplied for the KPIs to produce individual quarterly pathway standards reports for each local provider.

2. The programme sends the quarterly pathway standard report along with the KPIs to each programme manager and clinical lead for sign off. We also send copies sent to SQAS (regions) for information. Concerns regarding data quality should be emailed to phe.desdata@nhs.net. If no concerns are raised within 3 weeks, we assume that the data is accurate. Please note that you can use the screening to treatment timeline outcomes tracker to validate the referral information, and tracker figures can be used if they are more accurate.

3. Concerns regarding data quality are resolved between supplier, local provider, SQAS (regions) and the DES programme as appropriate.

4. Once data quality issues are resolved, the local provider runs the performance reports again and send to the DES programme so that any changes are reflected.

5.The programme sends the finalised pathway standards report to programme managers and the relevant SQAS (regions) by the KPI publication date.

The report can be used for quarterly programme board meetings and to inform discussions between the local providers and SQAS (regions). It should be noted that the data in the quarterly pathway standards reports will be provisional and that only standards that can be reported on quarterly will be included. It is the responsibility of the local providers to distribute the report to commissioners and screening and immunisation teams. We encourage local screening providers to share their report as soon as it is provided.

4. Annual pathway standards report

The DES programme produces these reports for each local screening provider on an annual basis to cover the screening year and include information on all standards.

Local providers are required to submit one programme performance report or DES performance report for the whole programme, plus individual reports for each clinical commissioning group (CCG) within the programme by 31 October for the preceding financial year (this is to allow for non-attendances and the longest recommended times between diagnosis and treatment). The annual report is in addition to the quarterly reports submitted in September and December.

Data is produced as per steps 1 to 5 for the quarterly pathway standards.

The programme emails the finalised report to the programme manager and relevant SQAS regional offices by 31 December.

It is the responsibility of the local provider to disseminate the report to commissioners and screening and immunisation teams. We encourage local providers to share their report as soon as it is signed off. The report can be used to support the assessment of local providers at quality assurance visits.

1. For local screening providers using NPS software this is the ‘programme performance report’. Local screening providers are not required to submit any other system specific reports to the Diabetic Eye Screening (DES) Programme. ↩