TB Do Once and Share Project
Summary
This project provides an important opportunity for integrating clinical and public health requirements for information management for the detection, management and prevention of tuberculosis, and for representing those integrated requirements to Connecting for Health. Full engagement with the wide range of stakeholders involved in implementing the National Action Plan, the NICE guidelines (when finalised) and the HPA Programme on tuberculosis, will be key to realising the potential benefits of the project. The project team have made a good start to this process of engagement, but achievement of the objectives will be dependent upon being able to achieve rapid consensus on care pathways and information needs with these stakeholders.
Background
London has the highest TB rate (just below 40 per 100,000 population) of any region in England and Wales - three times higher overall, and up to ten times the national rate in certain boroughs. Rates have been rising for over a decade. Almost all cases of TB are preventable, and almost all people with TB can be cured.
During the late 1980s London accounted for around 30% of all TB notifications in England and Wales. During 2003 there were 2785 notifications made in London, 42% of all those made in England and Wales. Of the 33 local authorities in London 14 had TB rates over 40 per 100,000 population in 2003. There were only 5 local authorities in London with a rate lower than the national rate of 11.2 per 100,000 population.
In 2004 the Chief Medical Officer published a TB Action Plan, Stopping Tuberculosis in England and Wales. In the Action Plan, the CMO notes that “in the United States of America (USA) tuberculosis re-emerged during the 1980s and early 1990s. The disease was out of control. With a clear plan, a national focus, and a build up of infrastructure and resources at local, state and national levels, the tide was turned. Between 1992 and 2002, TB cases decreased by 45 per cent and rates of TB halved to five per 100,000 population, the lowest ever recorded. Control of TB in this country can be achieved with a similar level of commitment to that shown in the USA.”
The Action Plan identifies 10 key areas for action:
1: Increased awareness
2: Strong commitment and leadership
3: High quality surveillance
4: Excellence in clinical care
5: Well organised and co-ordinated patient services
6: First class laboratory services
7: Highly effective disease control at population level
8: An expert workforce
9: Leading edge research
10: International partnership
The Department of Health has established an organisational framework for implementation of the Action Plan, with working groups on commissioning, service delivery, and monitoring and surveillance. In London, the ‘Stopping TB in London’ initiative has been taken forward through a group representing the five TB Networks and the HPA, and seven workstreams.
The evidence-based guidelines for delivering TB services, National clinical guideline for diagnosis, management, prevention, and control of tuberculosis, have been developed by the National Collaborating Centre for Chronic Conditions of the Royal College of Physicians, and were published in June 2005 as the first draft for consultation of what will become a NICE guideline. This guideline deals with activities undertaken by different professionals in the NHS, with multiple aims: to diagnose primary cases, to identify secondary cases, to treat active disease, to control latent infection, and to prevent further transmission. The guideline not only addresses case management but also provides recommendations, wherever there is evidence to support it, on ways of organising services efficiently to provide the best possible care.
Delivery of the Action Plan, nationally and in
London, and implementation of the national guidelines will require tight integration of clinical and public health services, and integrated or interoperable information systems to support coordinated working. Do
Once and Share provides an important opportunity to map out both the clinical and public health elements of care pathways and define the configuration of services required to implement the new guidelines and achieve the goals laid out in the Action Plan. It also provides a single common pathway to the National Programme for Information Technology for the various structures that have been established to deliver the national Action Plan.
