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New guidance helps GPs diagnose bowel conditions

Posted: 28th June 2018

A new national care pathway to help clinicians to simply and accurately distinguish between patients with Irritable Bowel Syndrome (IBS) and patients with Inflammatory Bowel Disease (IBD) has been developed.

The new pathway encourages primary care clinicians to use faecal calprotectin testing as a decision diagnostic. Evidence suggests that implementing a faecal calprotectin test in primary care reduces diagnostic uncertainty for patients as well as the number of unnecessary hospital referrals for further invasive and unpleasant diagnostic treatment.

Alongside benefits to patients, Clinical Commissioning Groups (CCGs) have identified significant financial savings through the reduction in unnecessary referrals to secondary care. Reducing unnecessary referrals also enables improved management of endoscopy services and the potential to reduce waiting times for patients requiring additional tests.

NHS Business Services Authority’s (NHSBSA) Pacific team carried out benefits analysis on two CCGs piloting the test, using the results to develop a national model and proposal to NHS England’s Chief Scientific Office (CSO).

To oversee the use, spread and adoption of faecal calprotectin testing in primary and secondary care settings a working group established by the NHS England Chief Scientific Officer led by Consultant Clinical Scientist Dr Martin Myers, brought together key partners from across the healthcare system including leading clinicians, academics, representatives from Academic Health Science Networks and colleagues from NHSBSA Pacific with input from Crohn’s and Colitis UK.

A consensus paper published by the group supports the implementation of the NICE recommendation for the use of faecal calprotectin in distinguishing between IBD and IBS (NICE DG11). The paper, endorsed by NHS England CSO, NICE and The British Society of Gastroenterologists, clarifies how the test should be used effectively in primary care and has been heavily influenced by the York faecal calprotectin pathway developed by Dr James Turvill.

To view the updated clinical guidance from NICE go here.

The NHSBSA Pacific team is collaborating with Yorkshire & Humber Academic Health Science Network (AHSN) to encourage spread and adoption of faecal calprotectin testing and is leading the development of a national model to measure benefits. Yorkshire and Humber AHSN has been at the forefront of faecal calprotectin testing implementation in primary care and has identified significant financial benefits, predicting savings of up to £2.5 million for the Yorkshire and Humber area alone.

Jackie Glatter, Health Service Development Manager at Crohn’s and Colitis UK, said “Many people with Inflammatory Bowel Disease report a delay in getting a diagnosis. This has a big impact both for the individual and for the NHS as the longer a diagnosis takes to make, the more likely a patient is to require aggressive medical therapy or surgery. This pathway, if widely adopted, together with use of the GP toolkit at should go a long way to improving this situation.”

Building on the success of Yorkshire and Humber, the AHSN national network has recently confirmed that faecal calprotectin testing has been selected as one of its collaborative projects and has agreed to support CCGs with the spread and adoption nationally. The AHSN has developed a suite of implementation tools including educational videos, business case templates and patient information leaflets, to assist with implementation.

Yorkshire & Humber AHSN also hosted a webinar to share details of this initiative with other AHSNs in June.

The NHSBSA Pacific team will also provide support to AHSNs and CCGs to measure benefits locally and other supporting materials. NHSBSA’s Pacific team is helping deliver sustainability for the NHS by identifying, developing and delivering opportunities which create financial savings for reinvestment into patient care, enhance health and wellbeing and improve the quality of patient care.

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