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Regional Innovation Fund 2010/11 Project: PC 10010

Establishment and Development of a Nurse-led Community-based Hepatitis C Treatment Service

University Hospitals of Leicester NHS Trust
This project allows patients who are infected with the chronic Hepatitis C Virus (HCV) to be treated outside the hospital environment, thereby improving patient uptake, compliance and acceptability of treatment. The service will be sited within the community to maximise accessibility for this hard to reach patient group.
HCV is a blood-borne viral infection which leads to chronic infection in 80% patients. Untreated HCV eventually causes cirrhosis of the liver, liver failure/liver cancer and eventually without transplantation may lead to death.
HCV however is potentially curable.
Treatment usually involves 6-12 months of weekly interferon injections and daily ribavirin tablets. This treatment is expensive, has many side effects and requires constant monitoring.
In the UK, HCV infection is common in patients who have been intravenous drug users. This group of patients do not interact well with traditional NHS services and often have problems with alcohol and mental illness. They also commonly come into contact with the criminal justice system and for all these reasons there is a high rate of non-attendance in the viral HCV clinic at Leicester Royal Infirmary.
In Leicester, HCV is also common in the Black and Minority Ethnic (BME) community and especially in the South Asian and Pakistani community. For all these reasons we believe that delivering HCV treatment in the community would improve compliance, allow us to treat more patients (including patients that we would not normally reach), and would be much more acceptable to this difficult to reach patient group.
This Project will allow patients with chronic HCV infection to be treated outside the hospital environment, thereby improving patient uptake, compliance and acceptability of treatment. We aim to provide nurse-led community treatment of HCV within, and with the support of, a range of existing services in Leicester, including the homeless centre (The Dawn Centre), a number of primary care settings in high-risk areas and within category B/C/D prisons in Leicestershire.
The treatment service will be sited within these community settings in such a way as to maximise accessibility for this hard to reach patient group.
There are a number of examples of community HCV treatment services elsewhere, but to our knowledge, this model of a nurse-led service outreaching to several different sites and supported by various Primary Care organisations has not been reported.

 

  • Treating HCV in the community will be significantly more acceptable to patients.
  • Patients will be treated in a familiar environment closer to home and will not need to make regular journeys to the hospital with all the difficulties that are associated with this.
  • Minimum disruption to normal life
  • We will be able to treat patients who would not normally access hospital services (e.g. patients in the homeless centre).
  • Prisoners will get equitable access to HCV treatment.
  • There will be a reduction in waits for assessment and treatment.
  • Improve patient motivation.

 

  • Community-based clinicians will see their patients (who would not normally be given the chance of cure), undergo treatment.
  • Community-based services will get first-hand experience of treating HCV.
  • Improved partnership working.
  • Improved quality of communication between agencies
  • The HCV nurse will become an important resource for Specialist Hepatitis Service, the Dawn Centre and Primary Care.
  • The community-nurse will be able to make a difference to this hard-to-reach patient group and by preventing the development of chronic debilitating liver disease will save the health economy a significant and expensive disease burden in the future.
Release significant financial savings by:
  • Avoiding the need for attendance at Consultant-led Specialist Clinics.
  • Avoiding the need for Prisoner escorts
  • Employing a nurse the PCT would release tariff charges for specialist nurse clinics in Hospital
  • Enable prisoners to get treatment within 18 weeks.
  • Allow University Hospitals of Leicester (UHL) clinicians to concentrate on complex patients.
  • Increased patient acceptability means more patients will be treated.
  • Do Not Attend (DNA) rates for outpatient clinics will reduce
  • Curing more patients reduces the disease burden and the need for specialist liver services to treat cirrhosis, provide liver surgery and transplantation, which are very expensive.
Current hospital treatment pathway (tariff cost for clinics/manpower only- excluding non-face-to-face) is £2899 per patient cured. A specialist nurse at Band 7 / mid-point 6 would be £44,169, inclusive of on-costs. 16 patients treated in the community would cover the cost of this post. Nationally, HCV nurses have a maximum workload of 50 cases per year.
Current cost for 50 patients = £2899 x 50 = £144,950
New cost for 50 patients = £50,000
Therefore releasing £94,950 back, as a whole community saving.
Additional costs will be released from the PCT budget by the liberation of prison officers from performing escorts to UHL for clinics (£57 + £50 per hour)
Average cost of prison escort estimated to be £207 per visit (approx £10,000/yr)
Increasing patient compliance by making treatment more acceptable will increase cure rate and decrease DNA rate. The benefit of DNA reduction will also be seen within UHL
RIF Project PC 10013 Image
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Contact the Innovator

Dr Allister Grant, Ivan Brown, University Hospitals of Leicester NHS Trust

Allister.j.grant@uhl-tr.nhs.uk Ivan.browne@leicestercity.nhs.uk 

 

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 Documents to Download

 

East Midlands EXPO Poster

See the project featured in the East Midlands Regional Innovation Fund Projects Brochure on Page 48