The Evidence-based Interventions (EBI) programme is an initiative led by the Academy of Medical Royal Colleges to improve the quality of care. The programme is supported by five partners: NHS England, NHS Confederation, the Patients Association, the National Institute for Health and Care Excellence (NICE) and Getting it Right First Time (GiRFT).
Created by both doctors and patients, as the name suggests, it is designed to reduce the number of medical or surgical interventions as well as some other tests and treatments which the evidence shows are inappropriate for some patients in some circumstances. In some instances, clinicians recommend we carry out more procedures because this will result in an improved quality of life for patients in the long term.
As well as improving outcomes it also means we can free up valuable resources so they can be put to better use elsewhere in the NHS. This is more important than ever as the NHS recovers from the impact of COVID-19 and restores services. We also know that sometimes these interventions can do more harm than good.
The Evidence-based interventions programme was developed in 2018 to help ensure a national approach to quality improvement takes place and that best practice is spread across the healthcare system. From the outset it had the following key principles:
- Improve the quality of care for everyone
- Reduce the risk of harm to patients
- Minimise unwarranted variation in service provision
- Optimise the use of finite resources and ensure any money saved is spent on other, more effective treatments.
The EBI programme has three stages to ensure clinical appropriateness and transparency:
- Tests and treatments and procedures for inclusion in the EBI Programme are proposed by a series of Expert Working Groups (EWG), comprising clinicians and subject matter experts.
- The EWG make recommendations to the EBI Expert Advisory Committee (EAC), which is made up of clinicians, commissioners, data experts, academic and patient representatives. The EAC reviews the recommendations against a series of criteria.
- If on the basis of the clinical evidence, there is a case for change the EAC refers those recommendations to the EBI Programme Board, comprising the programme partners, which accepts or rejects them.
The recommendations which the Programme Board accepts are then released for public consultation. If the recommendation passes this final stage, it becomes part of statutory clinical guidance to clinicians and commissioners or best practice.
In its first year alone the EBI programme saved the NHS more than £200m by not carrying out more than one million inappropriate procedures.
There are now 58 tests, treatments and procedures in the EBI programme. Some, such as knee arthroscopy where osteoarthritis is present, should never be carried out and have been almost eradicated. Others, such as tonsillectomies, which should only be carried out in certain circumstances where specific criteria are met, have been dramatically reduced.
In the 2022/2023 financial year the EBI programme has ensured over half a million inappropriate or unnecessary interventions have been avoided.
Professor Sir Terence Stephenson, Co-Chair.
Chair of the Health Research Authority and Nuffield Professor of Child Health, UCL
Dr Catherine Calderwood, Co-Chair
National Clinical Director, Centre For Sustainable Delivery
Dr Graham Jackson
National Clinical Advisor Elective programmes NHSE
Dr Catherine Thompson
Director for the Improving Planned Care Programme and Clinical Commissioner, West Yorkshire and Harrogate Health and Care Partnership
Dr Josephine Sauvage
Clinical Commissioner, NHS North Central London CCG
Dr Ash Paul
Public Health Consultant, South West London CCG
Mr Tim Mitchell
President, Royal College of Surgeons of England
Professor Adam Elshaug
Professor in Health Policy and Director, Centre for Health Policy, University of Melbourne
Dr Tim Wilson
Managing Director Oxford Centre for Triple Value Healthcare and Honorary Clinical Fellow University of Oxford
Professor Danny Keenan
Medical Director, Healthcare Quality Improvement Partnership
Programme Director, Centre for Guidelines, National Institute for Health and Care Excellence
Dr Sarah Markham
Strategic Co-production Group, NHS England and NHS Improvement
Jeanette Dickson, Chair
Academy of Medical Royal Colleges
Acting Director of Health and Social Care, NHSE
Director of Programmes and Transformation Delivery (National), NHSE
Medical Director for Transformation (Regional – London), NHSE
Chief Executive, Patients Association
EWG Chair, Clinical Advisor
NCD for Elective Care (Vascular & G Surgery), NHSE
NCD for Elective Care (Urology), NHSE