BTS/APPG surveys 2007

1. BTS/APPG surveys 2007 • TB Medical leads in England, Wales & N Ireland • PCTs in England

2. TB medical leads survey 2007 • 40 questions, on-line survey • Sent to 184 TB medical leads • Explored • TB team/workforce/facilities • Service organisation • Number of TB cases • Lab services • Screening & contact tracing • Case management • Issues now & in the future

3. BTS/APPG on TB PCT survey 2007 Determine the degree to which key elements of TB toolkit were being implemented Survey questions Incidence & popn changes PCT TB lead Testing & screening Priority setting Awareness raising Collaborative working Sent to 152 PCTs. 101 (66%) responses

4. What to do? • Implement change • Meeting with CMO • Parliamentary questions • DH initiatives • Launch of UK Coalition to Stop TB • Repeat surveys (APPG, BTS, RCN & TB Alert) • TB medical leads (Feb 2009) • TB specialist nurses (Jan 2009) • PCTs (May 2009)

5. MDTs – joined up working • Department of Health funding received Feb 2008 • Overseen by BTS Tuberculosis Specialist Advisory Group • 2 strands to the project: • Support and development of pilot MDTs • Development of a Clinical Advice Network

6. Project assumptions Professional decision making about TB management should not be made by isolated clinicians All professionals working in TB management should have access to quality, up-to-date information on best practice Education for junior clinical staff should be facilitated to ensure there is a “next generation” of experts Communication between professionals to be encouraged; and to build on existing networks to enhance patient care

7. What is an MDT for TB? • A meeting of a range of professionals, not just one TB clinician and a nurse, to discuss the management of TB cases • Value placed on innovation: the aim is to be flexible to meet the needs of individual services • Not like a cancer MDT! • No formal rules on membership • No formal funding structure

8. MDT progress • Global email sent to BTS TB leads asking for volunteers for the project (April 08) • 40 expressions of interest received for the MDT pilot scheme (both high and low incidence areas) • Some already working in MDT structure • Others seeking to set up MDT

9. Where are the pilot sites?

10. Ongoing data collection AIM • To provide information on process and procedure of meetings eg who attends, frequency, number of cases considered, collaboration with other units • All those registered in the project return quarterly data – first set = Oct-Dec 08 • Not an audit of services or comment on quality of care

11. First dataset Oct – Dec 08 • 23 colleagues, representing 39 Trusts returned information • 14 respiratory consultants • 5 TB nurses • 2 ID physicians • 1 ID SpR

12. Collaborations • 9 have MDTs that cover more than 1 NHS Trust (largest = collaboration across 5) • 4 of these groups are new & being developed • 1 holds “virtual” meetings as required • 4 groups gave an indication of the number of cases seen: 40-55 (new and review) cases

13. MDT Format • 13 only considered complex cases (6 reported that all cases were discussed) • 12 considered patients under 16 yrs • 13 normally prepare an agenda • 12 microbiology reviewed in all cases • 14 monitored therapy compliance • 15 considered infection control issues • 9 discussed patients lost to follow up • 6 discussed clinic DNAs

14. Complexity of cases • 11 MDTs reported cases with social co-morbidity • 10 reported cases of HIV co-infection • 7 liver disease • 4 kidney disease • 4 mental health issues • 3 substance misuse

15. Seeking advice on complex cases • 16 reported seeking outside advice • 8 groups had sought advice once • 6 groups had sought advice twice • 1 group 3 times • 1 group 4 times • Reasons • Drug resistance (11) • HIV (4) • spinal TB (3) • CNS TB (2) • social co-morbidity (2)

16. MDT: What next…. • Continue with the quarterly data collection to build up a profile of the work of the MDTs • Chance to follow established groups and also learn with those establishing new MDTs • Development of a programme of support for new and existing MDTs • All new members welcome! • Continue to develop dedicated website and good practice area, with opportunity for CQI

17. TB MDT: how to get involved Contact Louise Preston tb@brit-thoracic.org.uk Look at the website! http://www.brit-thoracic.org.uk/ClinicalInformation/Tuberculosis/ManagementofTBServices/tabid/310/Default.aspx

18. Clinical Advice Network • The MDT project should help to encourage collaboration between neighbouring units / trusts • Principles: • TB should be managed by more than one clinician • TB care, and indeed professional development is enhanced by collaboration with colleagues • Not one small group of “experts”, rather it will maximise enthusiasm and capture the next generation of experts

19. DGH DGH DGH

20. Improving the quality of TB care Extend the concept of an “advice network” to all aspects of TB.

21. 3 monthly Regional TB Meeting HPA PCT North City ID Unit 50 new cases/yr 1 TB Nurse shared with Central South City 10 new cases/yr 6 monthly steering group meeting Respiratory Chair Microbiology Lab Central City TB Unit 3 Respiratory Consultants 3 TB Nurses 1 TB Admin asst 1 Pharmacist 140 new cases/year monthly TB clinic weekly screening clinic contact tracing/ new entrants Microbiology Lab Microbiology Lab IGRAs Mycobact Reference Laboratory Molecular tests Paediatrics 2 Respiratory Consultants 15 cases / yr Monthly TB clinic Share TB nurses HIV ~900 cases ~10 TB/yr Shared care Weekly MDT X-ray MDT