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Framework for the provision of tuberculosis services for people living in Wales

Framework for the provision of tuberculosis services for people living in Wales. Dr Arif Mahmood Specialist Registrar in Public Health National Public Health service for Wales. Aims of this presentation. Why do we need a core TB service in Wales?

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Framework for the provision of tuberculosis services for people living in Wales

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  1. Framework for the provision of tuberculosis services for people living in Wales Dr Arif Mahmood Specialist Registrar in Public Health National Public Health service for Wales

  2. Aims of this presentation • Why do we need a core TB service in Wales? • How the current TB services are organised? • How the TB services should be? • Key aspects of this framework for commissioning TB services

  3. The Policy Context • NICE TB Guidelines 2006 • JVCI BCG Recommendations 2006 • DH toolkit on commissioning TB services June 2007

  4. TB epidemiology in Wales (1)

  5. TB epidemiology in Wales (2)

  6. Why do we need a core TB service in Wales? • Public health implications • Microbiological implications • Financial implications • Population demographic changes affecting Wales

  7. Key objectives of a core TB service • An effective BCG vaccination programme • Screening and contact tracing services • Effective management of TB - both TB and latent TB infection (diagnosis and treatment) cases • Clear policies for the management of MDR TB and cases co-infected with HIV • a resource for advice and information

  8. Current TB services in Wales • Community based services (GPs, Health Visitors and District Nurses) • Hospital based services • TB / Respiratory physicians and nurses, paediatricians and Infectious Disease physicians • Medical admission teams and other specialist clinical teams • Microbiologists, Infection Control Doctors and Nurses • The NPHS Wales Centre for Mycobacteriology • The NPHS Health Protection Teams • The NPHS Communicable Disease Surveillance Centre

  9. How the TB service should be? (1) • LHB TB commissioning lead for group of LHBs for planning and commissioning TB services from secondary care • The service should cover all elements of the TB service • Different elements of TB service to be provided by the most appropriate provider to suit local circumstances

  10. How the TB service should be? (2) • TB Lead Clinician (hospital or Trust depending on number of cases seen) • Named Case Worker (TB Specialist Nurse) • Multidisciplinary Team • Enhanced case management • Specialist TB centre

  11. LHB TB commissioning lead • Development of a comprehensive local plan for TB prevention and control, covering all elements of TB • Determining what and how TB services are to be provided locally meeting the local needs • Ensuring that services are commissioned against the local plan • Partnership working with key stakeholders • Working closely with the National Public Health Service to facilitate the identification of any potential outbreaks or rises in prevalence

  12. The lead TB clinician • to liaise with commissioners in planning, developing and commissioning TB services • to coordinate inter-hospital and intra-hospital multidisciplinary team activities • to liaise with peers at local or regional level and seek advice from Specialist TB Centre in Cardiff • to liaise with paediatricians in the management of TB cases in children • to liaise with the Local Health Protection Team (CCDC) of the NPHS to address wider public health issues • to coordinate and facilitate clinical audit and peer reviews of TB cases

  13. The named case worker • to assess health and social needs of all suspected TB cases on first consultation • to undertake risk assessment to identify those who may need ECM • to develop an individual care plan • to arrange and provide support to patient to ensure compliance and completion of treatment • to ensure treatment delivery and supervision (esp. DOT cases) • to educate patient and immediate family members • to arrange screening and contact tracing

  14. Enhanced case management • Enhanced case management (ECM) – a seamless care having both clinical and psychosocial care elements • A TB patient with complex needs should be offered ECM • ECM will be coordinated by the named case worker and delivered by a multidisciplinary team as appropriate

  15. Performance management • key performance indicators capturing various aspects of TB service be agreed both by the commissioners and providers • an audit system be set up to measure the performance against these key performance indicators

  16. Acknowledgements We are grateful to colleagues in the TB group, in the NPHS, WAG and LHBs for the help and advice in developing this framework.

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