Table 5 Audit of TB services against items from the national TB Action Plan

1. Have you had a formal peer review against the NICE guidelines?

No

No

No - Scottish guidelines still awaiting agreement

Internal review

No - regular audits and epidemiological review

Formal reviews are carried out in NE and NC London

Annual audit against NICE guidelines

Yes

2. Do you have GP training days with a focus on TB in your area?

Yes

Annual

No

No

No training days solely for TB but regular presentations to GPs as part of other meetings

GP training days are not widely held

No

Yes

3. What did you do for the last World TB Day

Stands at supermarkets, mosques, community centres, four hospitals. Information leaflets about TB was sent to all Birmingham GP's

Nothing

Posters and information leaflets around health centres and hospital

Nothing

Public awareness campaign with representation in the community and specific event organised for primary care with information pack on a CD.

Most TB services carried out public awareness programs

Insufficient staff to do anything

Article in GP communication magazine; TB nurses involved in nurse education, annual evidence reviews and in the past had a stall in main shopping mall.

4. Having identified high risk groups in your area, what sort of educational outreach have you been able to do in the last 2-3 years?

Seminars in nursing and care homes, training of community nurses about TB, educational meeting in certain ethnic communities

Language barriers have prevented outreach work

High risk groups identified (alcohol problems), but no educational outreach

Yes.

First in 2011

Some work with community development workers around World TB Day and teaching sessions to community groups. Targeted representation at health fairs

TB Find and Treat has been actively involved in the homeless and intravenous drug users.

Just starting outreach with help of charity, TB Alert.

TB nurses have targeted practices with most TB cases; Somali community addressed by ex-patients and community leaders.

5. Does your local medical school give teaching on TB (do you do it)?

Yes

Teaching given in 3^rd and 5^th years

Yes - I give 1 lecture a year

TB is in the curriculum and all students that attend St James University Hospital receive TB teaching

Yes. 2^nd year lectures and tutorial on TB microbiology and clinical TB. I give a lecture annually.

All five medical schools provide teaching on TB.

Yes - I do it.

Yes - I do it.

6. How often does your TB Network meet and what is its composition?

3-monthly: physicians, paediatricians, TB nurses microbiologists, public health, pharmacists and commissioners

3-monthly

Physicians, TB nurses, GP.

6 monthly. Public health (2 CIECs), paediatrician, ID physician, TB nurses, respiratory physicians from each hospital, microbiologist.

a) weekly MDT with TB physician, ID physician, CCDC, TB nurses, microbiologist, PCR technician and pharmacist;

b) Leeds TB group quarterly with other hospital teams, primary care managers and co-opted as needed;

c) Twice yearly West Yorkshire TB teams

6 weekly meetings with respiratory physician, ID physician, HPA, TB nurses to discuss local epidemiology and difficult cases.

A London TB group has been meeting regularly since 2000. Meetings were initially quarterly, but have increased considerably over the last two years

6-monthly Manchester group.

Includes 3 hospitals primary care, public health, TB doctors and nurses, microbiologist, infectious diseases (HIV) doctor.

Regional group meets 1-2× per year. TB forum meets with commissioners 2 × per year. Monthly MDT with infectious diseases, respiratory physicians, TB nurses, laboratory staff, public health and paedicatricians.

7. Do you have a local prison? How many ex- or current prisoners did you treat for TB last year?

Yes

2

No

None

Yes.

Not recorded.

2 prisons - 1 case last year

2 prisons; 1 case per year.

A TB specialist nurse attached to the prison health service was employed from 2006-2010

Yes.

1-2 patients per year.

Yes (Doncaster); 2 per year

8. Do you have a named key worker (accountable case manager) for each TB patient?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

9. Are TB drugs free from your clinic?

Yes

Yes

Yes (Scottish national policy)

Yes

Yes

Yes

Yes

Yes

10. How many negative pressure rooms do you have in your hospital?

2 at Trust;

8 for Birmingham

6 at one site

2

4

13 in 2 trust hospitals

Variations in supply exist across London, ranging from 0 to 12 in specialist hospitals

None (available in a different hospital, under a different physician)

17

11. What percentage of TB cases came from screening programmes (contacts, immigrants, HIV₊ and other)

52/264 (19.7)

52/509 (10.2)

25%

Not available

18/125 (14.4%)

10% from contacts; 75% pulmonary cases identified by radiology based rapid access system

Not recorded across the capital;

11/29 clinics perform new entrant screening^a

6.9

1-2% per year

12. Do you have a joint TB-HIV clinic?

Yes

Run by infectious diseases physician

No

Just starting

Yes between ID and GUM physicians

All sectors have at least one TB-HIV clinic; only 3 of 29 clinics reported difficulty accessing an HIV service^a

No, but weekly joint MDT.

Same physician

13. What percentage of your patients had DOT at some point in their treatment last year?

21

0

None

3

5

Access to DOT is variable across London (range 1.7-32% of all patients)^a

2

5-10%

14. Target of 1 nurse per 40 notifications*

1:80-90 to 2008

1:60-70 from 2008

No specified TB nurses

Not achieved

Achieved

Achieved from 2000

Set 2000

Mostly achieved by 2007; range 1;21 to 1;51 in 2009^a

Not achieved

2 nurses from 2000

Achieved 2006

15. How many hours are assigned to TB in your job plan?

12

None - TB seen as part of general respiratory clinics

4

8

4

Varies from 0 to 16, but unrelated to TB numbers

2

4 for TB clinic and 12 in total.