A range of measures to help the NHS recover gastroenterology services and mitigate against surges of COVID-19 are outlined in the latest national report from the NHS’s Getting It Right First Time (GIRFT) programme.
Hospital gastroenterology teams (which include liver teams) care for millions of patients every year – gastrointestinal (GI) complaints account for one in ten GP consultations and digestive diseases are a factor in one in eight deaths.
The new national report offers practical solutions for managing the demand for services and optimising the capacity of units in England, with a particular focus on meeting challenges created by the COVID-19 pandemic, such as the backlog of patients waiting for endoscopic procedures and gastroenterology clinic appointments.
Vanessa Hebditch, Director of Policy at the British Liver Trust, says: “Liver disease is a silent killer - it shows few symptoms in the early stages. Sadly, three quarters of people with cirrhosis are diagnosed too late when there are very few options for treatment.
“We are delighted to have been involved in the GIRFT programme and fully support the recommendations. By working together and sharing best practice through GIRFT we can reduce variation in care and improve patient outcomes.”
What does the report include on services for people with liver disease?
Written by Dr Beverly Oates, GIRFT’s clinical lead for gastroenterology and a consultant physician and gastroenterologist at Wirral University Teaching Hospital (WUTH) NHS Foundation Trust, the report’s recommendations aim to ensure the right patients are prioritised and then cared for quickly, efficiently and safely.
Measures in the report include:
- More proactive care programmes for patients with liver disease: Liver disease is the biggest cause of death in those aged between 35 and 49 and the third leading cause of premature death. Proactive programmes, giving patients access to services such as community alcohol care teams or weight loss clinics, will help patients better manage their own condition, minimising the need to be seen in hospital and reducing emergency admissions for cirrhosis.
- Improving earlier diagnosis of liver disease: Best practice for assessing fibrosis involves using non-invasive tests – such as a blood test or ultrasound elastography scan (eg; fibroscan) – in many cases, but the GIRFT review found variation in their use. Allowing GPs to request a fibroscan and receive results directly can help with earlier diagnosis of liver disease as well as managing demand for secondary care. The GIRFT report recommends that trusts work with primary care to give direct open access for GPs to book scans.
- More six- and seven-day services and extended hours, to boost capacity and improve patient flow: Gastroenterology has expanded at a greater rate than any other acute major medical specialty over the past 30 years, due in part to increased demand for diagnostic and therapeutic endoscopy. Before the pandemic 71% of trusts had six- or seven-day endoscopy lists and 54% of trusts were doing weekend gastroenterology ward rounds, but more weekend and evening services are needed to meet demand, with additional recruitment to ensure staff do not burn out. Extra sessions will mean that patients can be seen more quickly and return home with minimal hospital exposure to COVID-19.
- Better triage to help streamline referrals: Early specialist triage will ensure the most urgent patients are seen first and identify those who no longer need to attend hospital, which will reduce waiting times for those that do. The report also recommends closer working with primary care colleagues to improve awareness of services which allow patients to better self-manage their condition.
The in-depth GIRFT report is based on visits to all 129 NHS trusts in England providing gastroenterology services and features more than 20 examples of best practice seen by the team during their 18-month review. The recommendations also present the opportunity for potential cost efficiencies of between £35m and £62m a year.
Healthcare professionals can read the full report here: FutureNHS Collaboration Platform - FutureNHS Collaboration Platform