Hand holding a pen, filling in a form with a stethoscope in the background

Clinical Service Review and Audit

Review clinical practice to ensure compliance with commissioning policies

Clinical service review and audit provides a systematic way of reviewing current practice in relation to best practice, reviewing compliance with existing policy, making quality improvements, improving outcomes for patients, measuring the impact of changes made together with the potential to release substantial savings where procedures are undertaken outside national guidance or commissioning policy eligibility requirements.

What we do

SPH offers a full service for local and national clinical service review and audit, including:

  • Provision of independent consultant level clinicians or senior GPs experienced in clinical service review and audit
  • Development and use of bespoke audit tools to capture findings in detail at individual patient level where appropriate (e.g. secondary care compliance with patient eligibility criteria)
  • Analysis of data records in primary or secondary care to identify opportunities for pathway development (e.g. root cause of delays in cancer pathways)
  • Identifying systematic failures in patient pathways and root causes
  • Leading and facilitating workshops with primary care, secondary care and commissioner stakeholders to identify and develop opportunities for pathway improvement based on audit findings
  • Cash-leasing savings arising directly from clinical audit
  • No risk, gain-share engagement options

Why choose SPH?

  • SPH has a wide range of experience of undertaking clinical service review and audit
  • SPH is an independent NHS organisation and our consultant level senior clinicians are highly experienced and able to engage confidently and credibly with their clinical peers across primary and secondary care
  • We are prepared to consider no risk gain-share contracting arrangements where savings can be directly linked to audit activity; one of our secondary care clinical audits for an STP group of CCGs identified an aggregate annualised value of £1.9m for non-compliant procedures across 2 NHS Trusts and 3 non-NHS providers for primary hip and knee replacement, spinal injections, cataracts and grommets
  • Our audit activity has led directly to the release of savings and development of opportunities to improve pathways
  • Our clinical service review and audit experience includes:
    • Auditing of patient notes to determine secondary care compliance with commissioning policy (releasing savings and identifying opportunities to improve quality of care)
    • Condition specific studies (e.g. breast cancer care against standards for care)
    • Service review of referral practices (e.g. primary care cancer audit)
    • Diagnostic pathway auditing to identify pathway delays and their root causes (e.g. audit of 62 day cancer pathway)
    • Auditing use of particular drugs against guidance to ensure appropriate prescribing and access to treatments


As an example, our case study ‘Clinical Audit in Secondary Care’ summarises an audit of secondary care providers undertaking a range of procedures which SPH was commissioned to deliver by an STP group of CCGs.

For further information please get in touch via our contact page.

Case Studies

Improving allocative value decision-making in the stroke pathway (STAR tool)

The Mid and South Essex stroke stewardship group wanted to better understand which of the interventions they delivered were high value and which were low value to inform decision-making on use of resources and investment. Arden & GEM’s Healthcare Solutions team provided training and support to enable the group to use the Socio-Technical Allocation of Resources (STAR) process in value based decision-making. As a result, the MSE stroke stewardship group has the insight needed to improve the allocation of their existing resources and improve outcomes for their patients. SPH were part of the project team, conducting a librarian review of economic evidence relating to cost-effectiveness of the stroke interventions to feed into the first workshop. This comprised a review of existing economic cost-effectiveness assessments (ideally by NICE as these are recognised as the guiding authority within the NHS). Where an economic assessment had not been undertaken then this was noted for further consideration. More detail here

Health Needs Assessment for Children & Young People

SPH carried out a Health Needs Assessment for a local authority that was recommissioning its Healthy Child Programme (HCP). The purpose was to review whether existing provision and service configuration of the HCP was meeting the needs of children and young people in the county, and to identify gaps and potential options for improvement. This is a preventative programme which includes Health Visiting and School Nursing Services, Family Nurse Partnership (FNP) Programme and healthy start vouchers and vitamins, linking with childhood immunisation services, community paediatrics, speech and language, services for children with a learning disability and complex needs and child and adolescent mental health services (CAMHS), among others. The HNA was carried out jointly by SPH and the local authority, with the epidemiological needs assessment and service description provided by the local authority. The report was compiled using a range of publicly available and locally collected epidemiological and service use data. In addition, SPH carried out a consultation of key corporate stakeholders as well as children and young people, their parents and carers. This included semi-structured interviews with key stakeholders in a range of organisations, a survey of a wider range of staff who work with children and young people and a survey of children and young people, their parents and cares which was distributed through the services.

Clinical Audit in Secondary Care

SPH was commissioned by an STP group of CCGs to carry out a clinical audit of secondary care providers undertaking a range of procedures. We deployed an experienced consultant clinician, utilising our audit tool to review hip and knee replacements, cataracts, grommets and spinal injections across a mix of NHS Trusts and non-NHS providers. Patient records were selected randomly from a data extract and the audit tool was adapted to take full account of the complex eligibility criteria for each procedure. Our consultant clinician engaged with provider consultants/surgeons, to discuss and agree whether or not there was evidence in the patient notes that demonstrated each patient met the eligibility criteria in the commissioning policies. The aim of the audit was to establish the non-compliance rate for each procedure and provider, and also to uncover the key reasons underpinning any systematic non-compliancy. The aggregated annualised value of non-compliant procedures undertaken across the five providers was substantial at £1.9m and ranged from 15% to 80% of the annual activity value of each provider.

Audits on diagnostic pathways in primary care

SPH has undertaken primary care audits on diagnostic pathways for patients newly diagnosed with cancer for two regions of England. Commissioned by local clinical commissioning groups, together these audits included data from ~150 GP practices and ~3,600 cancer patients diagnosed within a 12 month period. The audits collected data on patient characteristics, symptoms, cancer type, location of first presentation and intervals in the diagnostic pathway, including identifying areas of potential delay. The analysis of the audit data highlighted variations between geographical areas and groups of cancer patients. They also provided an opportunity for GPs to reflect on their practice in the diagnosis and onward referral of patients with symptoms that might indicate cancer, build upon current good practice and inform service improvements.