QOF Plus Year 1 - Imperial College London

In 2007 the North West London Sector had one of the highest TB rates in the country (59.8 per100.000), and rates for Hammersmith and Fulham were reported to be 40.3 per 100,000 (Zeuner,2008). 87.5% of all new notifications in the UK were from residents born outside of the UK, and48.6% of cases where year of entry was recorded entered the UK within the last 5 years. (NWLondon TB Network, 2008). Inclusion of an indicator in QOF+ relating to early referral for TB newentrant screening and early referral has been locally identified as a way to address this.Priority and relevance to national policyThe Chief Medical Officer (CMO) identified TB as “new threat which needs concerted action todeal with it”. He laid out the government’s commitment and recommended next steps to tacklethis new epidemic in an action plan (DoH, 2004). This action plan was accompanied by a nationaltoolkit (DoH, 2007).The CMO’s action plan recommends in action 7 to “transform practices for improving casefinding, including targeted screening among high risk groups, in particular: *…+ disseminatemodels of good practice for screening new entrants to this country *…+” (DoH, 2004). Theproposed referral scheme is in line with national policies.Prevalence of conditionThere were 69 TB cases in Hammersmith and Fulham during 2007 (40.3 per 100,000) and thenotification rate of residents born outside of the UK was more than 2½ times higher than in UKbornresidents in 2006 (Zeuner, 2008).Associated morbidity and mortalityApproximately 10% of those infected will develop active TB disease (more, ifimmunocompromised or living in adverse living conditions). Untreated TB disease has a very highmorbidity and an almost 50% mortality rate. In addition, those with untreated pulmonary TB willtransmit their infection to approximately 10-15 others per year. However, appropriately treatedTB is curable and patients can resume a normal life with no or very few sequelae from this illness.Local contextTackling Tuberculosis locally was seen as a key priority for Hammersmith and Fulham and the2007/08 PCT Operating Plan includes speeding up access to treatment for suspected TB as a keypriority target (H&F, 2007). A local action plan has been agreed, based on best practicerecommended by NICE (2006). One of the three key areas is to “increase the percentage of newentrants who are screened for active and latent TB in line with NICE’s clinical guideline.”Identifying individuals at risk for TB at the point of GP registration was recognised as animportant area to support this key area.The proposed referral system was piloted in four local GP practices and the feedback from boththe practices as well as the TB service in Hammersmith Hospital was very positive. A more formalfinal evaluation of this pilot will follow.66