Endoscopy services are central to the NHS diagnostic pathway. Procedures such as gastroscopy, colonoscopy and flexible sigmoidoscopy are critical for diagnosing gastrointestinal disease, detecting cancer early and monitoring long-term conditions such as inflammatory bowel disease. Yet like many diagnostic services, endoscopy has experienced significant pressure in recent years.
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Across England, diagnostic services continue to face significant challenges, with endoscopy units seeing rising demand driven by an ageing population, increasing incidence of gastrointestinal disease, and the continued expansion of national bowel cancer screening programmes.
As a result, many trusts are struggling to meet the NHS diagnostic standard that requires 95 per cent of patients to receive tests within six weeks. Delays to endoscopy not only affect patient experience but can also slow access to vital cancer diagnostics, increasing pressure on urgent referral pathways and clinical teams.
Against this backdrop, many NHS organisations are exploring innovative service models to increase capacity and reduce waiting lists while maintaining quality and safety.
Rapid clinical capacity through insourcing
One approach that is increasingly supporting NHS recovery is insourcing, allowing trusts to bring experienced external clinical teams into their existing endoscopy units to run additional procedure lists, typically during evenings and weekends. As services are delivered using the hospital’s own estate and equipment, additional capacity can be mobilised quickly without requiring major infrastructure investment.
This model enables trusts to target areas of highest demand, such as surveillance colonoscopy backlogs, routine diagnostic gastroscopy and bowel cancer screening procedures. By creating additional diagnostic slots, insourcing can help protect urgent suspected cancer pathways, target DM01 pain points and support compliance with national waiting time targets.
Expanding the role of nurse endoscopists
Alongside insourcing, the development of nurse-led endoscopy services is playing an increasingly important role in strengthening the NHS diagnostic workforce.
Specialist clinical endoscopists, including advanced nurse practitioners, are now trained to perform a wide range of endoscopic procedures, including gastroscopy, flexible sigmoidoscopy and colonoscopy, as well as supporting vetting of referrals and histology reporting. Evidence has shown that when appropriately trained and supported, nurse endoscopists achieve clinical outcomes and safety profiles comparable to physician endoscopists.
By expanding these roles, trusts can significantly increase procedural capacity. Nurse-led lists are particularly effective for routine diagnostic procedures, surveillance endoscopy and screening programmes, allowing consultant gastroenterologists to focus on more complex therapeutic work.
This multidisciplinary approach improves service efficiency while maintaining high standards of patient care.
A complementary approach to service recovery
When combined, insourcing and nurse-led models offer a powerful solution to current endoscopy pressures. Insourcing provides rapid, flexible capacity that can address immediate backlogs, and nurse-led services help provide the platform for a sustainable workforce model for the future.
Together, these approaches allow NHS organisations to:
- Increase endoscopy throughput
- Reduce diagnostic waiting times
- Support cancer pathway performance
- Maximise utilisation of existing endoscopy suites
- Improve patient access to essential diagnostic care
As demand for endoscopy continues to grow, innovative workforce and service models will be essential in helping the NHS deliver timely diagnosis and treatment. By combining short-term operational support with long-term workforce development, trusts can take meaningful steps towards restoring diagnostic performance and improving outcomes for patients.
Safe, efficient clinical capacity that puts patients first
At 18 Week Support, we know first-hand how nurse-led teams can transform endoscopy delivery.
Our dual-trained, JAG-certified nurse endoscopists, trained through the JAG endoscopy training system (JETS) pathway, provide safe and efficient services with consultant oversight. Their KPIs are reviewed regularly by our clinical leads, ensuring quality, consistency, and alignment with national standards.
“Attentive, caring, empathetic and competent staff (All!) – overall, an unpleasant procedure was made as good as it could be. Bravo!” – Endoscopy patient, 18WS service at NHS trust.
To find out more, please contact – partnerships@18weeksupport.com
