A mixed-methods investigation of the delivery, impact and acceptability of a national de-adoption programme across Clinical Commissioning Groups in the English National Health Service



National Institute for Health and Care Research (NIHR) Health Service & Delivery Research (HS&DR) Ref. NIHR130547.

What is the research question?

To understand the delivery, impact and acceptability of NHS England’s Evidence-based Interventions (EBI) programme across English CCGs, with a view to producing evidence-informed recommendations to optimise future efforts to de-adopt low-value care.

What is the problem?

The NHS is under pressure to deliver high quality care with limited funds. As research progresses, some commonly used treatments are found to not work as well as we previously thought. These treatments can be called ‘low-value’ when they do not deliver enough benefit to justify their risks and costs. Stopping low-value care can release funds for more beneficial care and reduce unnecessary harms. Stopping or reducing a treatment that is currently available is referred to as ‘deadoption’. De-adoption could mean stopping a treatment altogether, or only providing it for patients expected to benefit. In 2019, NHS England launched the Evidence-based Interventions (EBI) Programme. This named 17 ‘low-value’ surgical procedures that NHS commissioners are required to stop funding, or only fund if patients fulfil set criteria stated in the EBI policies.

What is the aim of the research?

Our project aims to understand the delivery, impact and acceptability of the EBI programme, in order to produce recommendations to improve future efforts to reduce low-value care.

How will this be achieved?

We will achieve this in three stages, studying two procedures in detail: shoulder and wrist surgery.

  • Stage 1 examines changes in NHS care before and after EBI policies were issued.
    We will study changes in numbers of operations performed for each EBI procedure and changes in other operations that may be done instead.
  • Stage 2 will explore actions taken by commissioners and doctors in response to the EBI programme. It will also explore commissioners’, doctors’ and patients’ views about the consequences and acceptability of these actions. We will interview commissioners, GPs, and specialists to understand what has been done in response to EBI policies and their views about the consequences and acceptability of these actions. We will also interview patients being considered for surgery to explore their experiences and satisfaction with care, and audio-record clinical consultations where the procedures are discussed with patients to study what happens in front-line care. We will examine a wide selection of CCGs’ policies for accessing the EBI procedures, and send a survey to CCGs across England to capture actions taken in response to the EBI programme.
  • Stage 3 will combine results from the research above and consider findings in relation to up-to-date evidence. We will then work with patients, clinicians, commissioners and policy makers to write recommendations to support timely and acceptable reduction of low-value care.

Who is leading the research?

Dr Leila Rooshenas, Lecturer in Qualitative Health Science, Population Health Sciences, University of Bristol.

Further information:

Dr Leila Rooshenas

For more information or to get involved in this project, please contact bnssg.research@nhs.net.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.