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an Economist Intelligence Unit business healthcare

RCS Commissioning Guidance Support



The Royal College of Surgeons of England



The Royal College of Surgeons of England (RCS) is a professional membership organisation (and registered charity), supporting 20,000 members in the UK and internationally. It runs exams and courses to improve the skills and knowledge of members, produces policy and guidance to ensure best practice, and runs an innovative research programme to improve surgical care.


The problem

The RCS, working with the Surgical Specialty Associations (SSAs) led on producing a commissioning guidelines portfolio to enhance the delivery of surgical care within patient pathways.

The aim of the programme was to increase the value that individual patients and the population as a whole derive from care and treatment. The initial work was funded by NHS Right Care.  

Unexplained variation in practice was identified as an area where commissioners could potentially improve quality and increase value. The RCS and SSAs aimed to create guidance to help to address variation and provide detailed evidence for high value or low value procedures in 10 key speciality areas to inform commissioners’ decision-making.

Our solution

The client required a literature search process that would fit in to a wider guideline development process. Bazian designed a process comprising topic scoping (with feedback), literature searching, filtering and categorising of results. The process had to be rigorous and fit-for-purpose, balancing the client’s need for high quality searching with the rapid turnaround required. Gaining NICE accreditation was a key aim for the client, therefore we designed a process that would meet the relevant domains of NICE’s accreditation standards for guideline development.

Bazian provided additional ad-hoc support in the form of critical appraisal, producing graded evidence tables and writing a methods section for a sample guideline. This work was undertaken to support the client in their NICE accreditation submission following NICE’s initial feedback.

The outcome

Literature searches were completed for 35 topics across seven surgical specialties. All deliverable were delivered on time, with 70% sent ahead of schedule. Bazian delivered according to a reliable schedule that was flexible to the client’s need, this flexibility was important as there were delays upstream in the process which Bazian were, on occasion, able to absorb to reduce the impact on the wider process.

The additional ad-hoc work involved critically appraising and grading the 43 studies included in a sample guideline in an evidence table, then writing methods section for NICE accreditation submission. The Royal College of Surgeons successfully gained NICE Accreditation.


"Bazian provided us with a tailored and efficient solution to enable the College, working with our Surgical Specialty Associations, to deliver 25 evidence-based guidelines to support commissioners in their decision making about surgical services.  

Our process was accredited by NICE, so we needed to have confidence that the evidence search and support would stand up to scrutiny. Bazian delivered a complex programme of work on time and to budget. Their staff were highly knowledgeable and supportive."

Erana Sitterlé, Policy and Implementation Manager (Service Accreditation)