Shared learning database

Greater Manchester Public Health Network
Published date:
September 2011

A project to manage the development of a Greater Manchester hepatitis C service specification.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of this service specification is to introduce a standardised, best practice care and referral pathway for patients who are diagnosed with Hepatitis C across Greater Manchester. The introduction of a standardised, practice pathway for Hepatitis C will aim to: 1) Improve productivity 2) Release efficiencies 3) Improve patient experience through the delivery of patient-centred care with effective, auditable outcomes 4) Deliver high quality care through the delivery of best practice 5) Provide equitable access by ensuring services are delivered closer to the patient 6) Facilitate high quality referrals in line with agreed clinical thresholds 7) Increase HCV treatment locations The objectives of the Hepatitis C service are as follows: 1) Reduce the incidence of liver disease resulting from Hepatitis C over the long term within the population 2) Provide care closer to home appropriate to the needs of the patient 3) Implement streamlined, efficient, best practice pathways for Hepatitis 4) Improve patient experience and be patient focused 5) Ensure patients with Hepatitis C are provided with links to peer-led support 6) Be underpinned by informed decision making 7) Use high quality patient information 8) Provide equitable access 9) Increase choice 10) Work proactively with other health care professional to facilitate high quality referrals that are in line with local clinical thresholds

Reasons for implementing your project

The Greater Manchester Hepatitis C Strategy was funded by Greater Manchester Director of Public Health group with the agreement that it would lead the Service Redesign of the local HCV service. Service Redesign required because of a number of issues: 1) Lack of understanding of issue, including epidemiology, activity by providers and costs 2) GM purchasing power re drug procurement not utilized 3) Insufficient testing of current injecting drug users 4) Variation in tariff across treatment centre 5) HCV activity not coded by providers 6) No HCV specific service specification 7) Anecdotally there was an inequitable service in relation to numbers treated/LA area (post-code lottery) 8) No defined care pathway 9) Repeated first appointments as patients referred to none-treatment centres 10) Unnecessary referrals as patients without chronic disease referred 11) Post treatment patients requiring ongoing care remained in treatment centres without being referred back to local gastroenterologist 12) Service delivered in hospital setting as opposed to outreach settings

How did you implement the project

Epidemiology- GMHCVS commissioned University of Manchester to produce Joint Strategic Needs Assessment. This has modelled local epidemiology, suggesting that there is 14,000 and 15,000 cases of chronic hepatitis C in Greater Manchester. Stakeholder views - The principles informing this specification are based on a comprehensive Stakeholder Consultation. 207 major stakeholders were consulted including clinicians, patients from various high-risk groups, microbiologists, public health experts and commissioners (see attached). HCV testing- Dried Blood Spot testing through Drug Teams was introduced by Greater Manchester Hepatitis C Strategy in 2008 Drug costs - Greater Manchester HCV Strategy has led a project to reduce the cost of the drugs by tendering across Greater Manchester. The saving is difficult to quantify as previously providers entered into individual arrangements with pharmaceutical companies with value added attached which funded the cost of nurses and pharmacy time but is a 26% saving on list price. Baseline Activity Monitoring- The treatment is intensive and requires on average between 7 and 13 FU appointments, although these are increased if there are difficulties with the treatment such as side-effects or requirement for additional support or if the treatment length is increased due to the presence of cirrhosis. Care Pathway - Local treatment clinicians and two primary care physicians have agreed a Greater Manchester Clinical Care Pathway. The pathway is the basis of the service specification. Data collection-HCV is not separately coded, therefore data relating to activity is hard to obtain. Data collection is a requirement of the service specification. Service Specification- Attached Service Specification has been signed off by Project Sponsor, Clinicians and Greater Manchester Commissioner group

Key findings

The project is at implementation stage and therefore results have not yet been evaluated. However the Care Pathway is expected to decrease unnecessary first appointments, up to 25% of current appointments are for people who do not have chronic hepatitis C, and therefore will not require treatment. Also there will be a saving of cost of repeated blood tests. Also the aim of the project is that people with hepatitis C are referred directly to treatment centre and not to nearest DGH, again reducing cost of unnecessary first appointments.

Key learning points

The key learning point is that clinicians should be involved from the start of the project. The project would have progressed quicker if an agreed Care Pathway was completed earlier in the process.

Contact details

Siobhan Fahey
Programme Manager - Greater Manchester HCV Strategy
Greater Manchester Public Health Network

Is the example industry-sponsored in any way?