Leading the first National Clinical Audit of Perioperative Care

The RCoA was appointed in 2025 by the Healthcare Quality Improvement Partnership (HQIP) to deliver the first National Clinical Audit of Perioperative Care (NCAPC). This new national audit will, for the first time, provide a systematic assessment of perioperative care for adults undergoing elective major surgery, spanning the full pathway from referral to recovery.

NCAPC aims to improve patient outcomes and experiences by reducing unwarranted variation in the delivery of evidence‑based perioperative care. By benchmarking practice and supporting structured quality improvement, the audit will help shape national practice and support sustainable improvements across perioperative services.

As a leader in perioperative medicine, the RCoA, alongside the Centre for Perioperative Care (CPOC), is ideally placed to lead this work. NCAPC forms part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), overseen by HQIP and funded by NHS England. The audit will initially be delivered for NHS‑funded care in England and publicly funded care in Jersey and will run for three years in the first instance.

Why a national audit is needed

There is strong evidence of unwarranted variation in perioperative care delivery across NHS organisations, with associated differences in patient outcomes and experience. While national audits such as the National Emergency Laparotomy Audit (NELA) and the Perioperative Quality Improvement Programme (PQIP) have demonstrated the power of benchmarking and transparent reporting within defined populations, there is currently no national audit focused on generic, cross‑cutting perioperative processes across adult elective surgery.

National standards consistently emphasise a whole‑pathway approach to perioperative care, including early referral, shared decision-making, screening, needs-based assessment, optimisation/prehabilitation, perioperative risk assessment, postoperative recovery, and rehabilitation. Despite this, implementation of evidence‑based perioperative practice remains inconsistent. Areas such as shared decision-making, identification, management of frailty, perioperative screening and optimisation, and early recovery processes are particularly variable, meaning that patients may not consistently receive care aligned with best evidence.

NCAPC has been designed to address this gap by supporting systematic identification of variation, enabling organisations to benchmark their practice, and providing a clear framework for quality and outcomes improvement across the perioperative pathway.

Progress to date

Since appointment by HQIP, significant progress has been made in establishing the foundations of the audit:

• Clinical leadership is in place, with the appointment of two national Clinical Leads and a Quality Improvement (QI) Lead bringing together complementary expertise across perioperative medicine, elective surgical care and QI practices.
• Work is underway to establish robust governance and oversight arrangements, including a multidisciplinary Strategic Oversight Board and Clinical Reference Group, ensuring strong clinical, methodological and patient representation.
• A multidisciplinary project team has been assembled, bringing together audit delivery, clinical, analytical, QI and patient involvement expertise.

This early phase of work has focused on creating a strong clinical and governance framework to ensure that NCAPC is credible, relevant and impactful from its first cycle.

Developing perioperative standards

A central aim of NCAPC is to define a core set of evidence‑based perioperative standards that are relevant across specialties, feasible to measure at scale, and meaningfully associated with patient outcomes and experience.

Several key principles are guiding standards development:

• Whole‑pathway coverage, reflecting the patient journey from referral and decision-making, through screening, risk assessment, optimisation, postoperative recovery and rehabilitation.
• Feasibility and data quality, focusing on measures that can be collected reliably and consistently across hospitals with a limited data collection burden.
• Actionability, prioritising standards that can directly support QI.

Standards refinement will include a scoping review of the literature, a scoping review of surgical, anaesthetic and perioperative medicine guidelines, a modified Delphi consensus, and expert multidisciplinary panels to bring together multidisciplinary professionals and the perspectives of patients with lived experiences. The process will also be informed by existing national guidance, learning from established audits such as NELA and PQIP. The goal is to create a standards framework that supports meaningful benchmarking while remaining proportionate and focused on improvement rather than data burden.

Patient and public involvement at the heart of NCAPC

Patients are being incorporated into the programme in multiple ways, including representation within the project team, membership on oversight groups and direct involvement in standards development. By integrating patient and public involvement (PPI) throughout the audit lifecycle, NCAPC aims to ensure that the standards it promotes reflect what matters most to patients, as well as to clinicians and health systems.

Next steps

The audit will run over three years:

• Year one will focus on finalising QI goals, governance structures and the core set of perioperative standards, and agreeing on the data to be collected.
• Year two will focus on national data collection.
• Year three will see the publication of the first national NCAPC report.

Further updates will be shared as the programme progresses. Engagement from clinicians, audit teams and patients will be critical to ensuring that NCAPC delivers meaningful, sustained improvements in perioperative care across the nation.