Shared learning database

Greater Manchester Hepatitis C Strategy
Published date:
June 2012

A project to raise awareness to local GP's about the new care pathway that was rolled out across Greater Manchester

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 the project is to ensure that GP's and primary care staff who work in areas with high levels of hepatitis C understand the Greater Manchester Hepatitis C clinical care pathway and are aware of the RCGP Certificate training course that is being funded by the Greater Manchester Hepatitis C Strategy. - Mail Information Pack to all GP's in Greater Manchester with letter
- Separate letter to the targeted 60 GP practices that have been identified as working in areas of high levels of deprivation or GP's who have previously identified themselves as interested in the topic offering training
- Follow up communication as required
- Provide 1 hour training package to 33% of the targeted 60 GP practices that have been identified as working in areas of high levels of deprivation or GP's who have previously identified themselves as interested in the topic.
- 100% of GP's who receive training to understand the new care pathway
- 90% of GP's who reply to survey 3 months post training to understand new care pathway
- 10 local GP's to attend RCGP training course

Reasons for implementing your project

The Greater Manchester Hepatitis C Service Redesign Project was started February 2009. The earlier stages of the project were:

Epidemiology - GMHCVS commissioned University of Manchester to produce JSNA. This has modeled local epidemiology, suggesting that there is 14,000 and 15,000 cases of chronic hepatitis C in Greater Manchester.

Drug costs - Greater Manchester HCV Strategy has led a project to reduce the cost of the drugs by tendering across Greater Manchester.

Outpatient tariff - 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 will be incorporated into the service specification. The pathway has been endorsed by the GM DPH group and has been uploaded onto Map of Medicine. The two main changes to the care pathway involve entrance and exit points. Entrance Point: In the new care pathway PCR, is carried out in primary care, and referrals are made direct to straight to treatment centre. Exit Point: The new care pathway would allow for patients post treatment who either remain HCV+ve or who are negative but have liver damage and require continued support to be referred to the local gastroenterologist after treatment - this will need to be a c2c referral as these patients require ongoing specialist care.

Service Specification - into provider contracts.

Data collection - HCV is not separately coded, therefore data relating to activity is hard to obtain. 2010-2011 activity has now been calculated using PbR excluded drugs as a proxy measure. The Final Stage of Phase II of Service Redesign Project is the GP Engagement Project.

How did you implement the project

Prepare information packs for postal marketing campaign, to include:
-Branded folder
-GM HCV Pathway document
-Information leaflet on getting tested for HCV
-Information about treatment and support for people with HCV
-Hepatitis C Trust leaflets
-BHA info packs to also include an introductory letter from Abdul Razzaq, Joint Director of Public Health. Two versions made:
-a generic letter regarding the pathway and RCGP course
-a second version which offered training on the pathway which was to be sent to a targeted 60+ GP practices that had been identified as working in areas of high levels hepatitis C and/or deprivation or GP's who had previously identified themselves as interested in the topic.
-GP database-update and use to send info packs to all
-Follow up communication as required
-Email GPs, drug services and other contacts regarding new pathway
-Call all 60 target GPs to arrange training
-Telephone script prepared for Communications Manager, Programme Manager and Administrative Assistant
-Preparation of FAQs to use during training
-Powerpoint presentation for events
-Delivery of training to at least 33% of target GP practices
-100% of GP's who receive training to understand the new care pathway
-Over 35 GPs/Practice Nurses to sign up to RCGP training
-Press Release-to advise media of new pathway and training being offered to healthcare practitioners -Complete a topic specific C View newsletter

Key findings

- All 600 GPs in the Greater Manchester Public Health Network database have received information pack and introductory letter from Director of Public Health regarding the new clinical care pathway.
- 60+ target GPs i.e. those based in high areas of hepatitis C and deprivation were sent and received the information packs plus a separate introductory letters offering training on the pathway plus information regarding the RCGP Certificate in the Detection, Diagnosis & Management of Hepatitis B&C.
- The Programme Manager, Siobhan Fahey, emailed all drug service teams and key workers from her own distribution list to advise of pathway training.
- Communication Manager visited all 60+ target GPs to hand in an information pack and to arrange a training session on the new pathway. I have been invited to do training at 20+ surgeries, where I have met with multiple GPs, Practice Nurses, Healthcare Assistants, Registrars, Practice Managers and Reception staff. This meant I achieved the original target of training in at least 33% of target GPs practices.
- Throughout the last 3 months surgeries have called to say they do not require training but have requested additional training packs. Posted or delivered them in person in order to try and book a training session.
- As of 25/04/2012, 22 people have registered on the RCGP training course and 17 others have expressed an interest. Many of these are resulting from visits, emails and correspondence sent via post.
- Presentation given on the new pathway at the Bolton PCT training event on 16/02/2012 and at the Tameside & Glossop Target event on 19/04/2012 as mentioned above.
- Completed and printed the 'C-View' newsletter for May 2012. This will be emailed to the Greater Manchester Hepatitis C Strategy Group, and a copy will be posted to all GPs in Greater Manchester. PDF version available Home - Hepatitis C website.
- Wide ranging media coverage was achieved

Key learning points

The GP engagement project has been very worthwhile. Through my visits to the 60+ target GPs all have said that they appreciate someone meeting them in person and those who arranged training advised that they were delighted to meet someone face-to-face and to have, at the very least, a refresher training on hepatitis C and to talk through the new pathway.

The pathway itself has been easy to explain to people and on the rare occasion I have been unable to answer questions e.g. medical questions beyond my role, these have been referred to Siobhan Fahey, the Programme Manager who has liaised directly with those people and answered their questions speedily.

The information pack mail out was straightforward and completed at the early part of my secondment. Media coverage was achieved even though we had not expected much coverage due the story simply being a pathway change as opposed to a patient story.

Contact details

Siobhan Fahey
Programme Manager
Greater Manchester Hepatitis C Strategy

Is the example industry-sponsored in any way?