Maintaining quality

Quality in Primary Immunodeficiency Services (QPIDS) is the accreditation scheme for adult and paediatric primary immunodeficiency (PID) services in the UK. It was established by the UK Primary Immunodeficiency Network (UKPIN) and is now hosted by the Royal College of Physicians. PID services engage in a self-led programme of quality improvement before being assessed against established best-practice standards, which have been developed after extensive consultation with the PID community and with patients. Those who are found to meet the standards are accredited for five years, subject to an annual renewal process.

The Improving Quality in Allergy Services (IQAS) accreditation scheme is the equivalent for adult and paediatric allergy services.

The key standards for the practice of immunology are detailed in the tables below:

Guidance

Comments

Specialist society and patient organisation standards and guidelines

NICE guidance and quality standards

eg referral of anaphylaxis

eg referral of drug allergy

  • NICE has produced a large number of technology appraisals, clinical guidelines and quality standards relevant to immunology (mainly allergy).

Other NHS standards specific to immunology

CPA/UKAS laboratory standards

Audits and appraisals

Comments

Supra regional and national audits

These are coordinated via immunology networks across the UK

National and international disease registries

Under the auspices of specialised commissioning, national registries of rarer disease are already maintained (eg UK immunology centres feed into the European Society for Immunodeficiencies (ESID) database ).

Local audit

Immunology units have local audit programmes which link to regional audits looking at both national guidance and local guidelines

Local and national peer review

Immunological peer review is achieved via local annual appraisal, and at intervals by accreditation inspection bodies.

Medical appraisal and revalidation

Participation in annual appraisal demands involvement in quality improvement ventures and patient surveys. These are also key requirements for revalidation and service accreditation

Internal governance processes

All trusts have rigorous internal governance structures for reporting and investigation of complaints and clinical incidents, and review of mortality

Accessing data for quality improvement                                                   

Accreditation schemes in immunodeficiency ( QPIDS ) and allergy ( IQAS ) are hosted by the Royal College of Physicians (RCP) and described above.  

Laboratory services are accredited by a UK inspectorate ( UKAS ) to internationally agreed standards. UKAS inspections occur on a 5-year cycle and are fully supported by the Royal College of Pathologists UK. Test results must be measured against performance in external quality control schemes, where shared samples are tested by participating labs to highlight poor performance and help to address it.

Commissioners require participation in both of these accreditation schemes.

The use of expensive immunotherapy is or will often be linked to funding. One way to regulate this could be through national databases that specify approved clinical indications and conditions of use. These national databases are at various stages of development.