The National Clinical Programme for Gastroenterology & Hepatology (NCPG&H) was established in 2019. Its aim is to design clinical pathways and guidelines to develop a Model of Care (MoC), for Gastroenterology and Hepatology services aligned with Slaintecare.
To achieve this aim five working groups were established, consisting of patients and Health Care Professionals (HCPs) including General Practitioners (GPs). The working groups are
1) Inflammatory Bowel Disease (IBD), 2) Advanced Liver Disease, 3) National Workforce Planning, 4) Complex Nutrition and Functional Bowel Disease and 5) Paediatric Gastroenterology, Hepatology and Nutrition (PGHN). A voluntary clinical lead has been nominated in each group. Prof Larry Egan is the lead for the IBD working group.
This vast Programme is overseen by a 0.5 WTE Clinical Lead (CL) Prof Colm O’Morain and a 0.5 WTE Programme Manager (PM) Mary Hamzawi, seconded from the clinical area.
The IBD working Group have developed the clinical pathway which will guide the Model of Care for all IBD patients nationally. Thanks particularly to the team in UHG, Aine Keogh and Mary Hussey and Prof Egan, for their time and input to finalise this pathway and ensure its approval within the HSE & DoH.
As of July 2022, the pathway has been accepted and awaiting confirmation from Department of Public Expenditure and Reform (DPER) to confirm how many CNS posts will be funded. The NCPG&H requested 35.8 IBD CNS posts be sanctioned nationally to enable the roll out of this pathway.
There are currently twenty-eight hospitals offering an IBD service to 50,000 patients.
Ten of these services are in level four hospitals: Beaumont, Mater, SJUH, SVUH, Tallaght, CUH, GUH, MUH, LUH, and CHI Crumlin.
The remaining eighteen are in level three hospitals.
There are eighty-five consultant gastroenterologists nationally, fifty-two in level four and thirty three across the remaining eighteen hospitals.
Thirty CNS /CNM2’s nationally
Four ANPs nationally
Two WTE psychologists nationally
3.9 dedicated Dietitians nationally (Stats as of July 2022)
Due to limited GP access to diagnostics such as Faecal Calprotectin (FCP) and the increasing number of referrals to the Gastroenterology services, it takes on average eighteen months for patients to receive an IBD diagnosis. Approx. 25% of patients often present to ED and are diagnosed as inpatients.
Currently, all hospitals are under resourced from a CNS/ANP perspective as per recommendations from the UK IBD standards Guidelines – Recommendation is for 2.5 IBD CNSs per 250,000 population, this gives a static caseload of five hundred per FTE. As IBD is a chronic disease requiring medication and lifelong clinical input, patient education, ongoing management and empowerment is essential to ensure patients are managed in line with Sláintecare goals.
Future State
NCPG&H IBD work stream aims to develop a national care pathway that provides GPs with better access to diagnostics including Faecal Calprotectin Stool Testing (FCP) as well as improved access to tertiary IBD Gastroenterology services. Such access will lead to earlier diagnosis and stream line more appropriate referrals to gastroenterologists.
The overall objective of is to improve waiting times for a diagnosis of IBD and provide national standardised access to specialised IBD care. This MoC can be developed through the employment and positioning of IBD CNSs at critical points throughout the pathway in collaboration with the multidisciplinary team.
The CNS will improve IBD patient triage, complete and streamline referrals for appropriate diagnostics, screening and blood monitoring. Ensure support and education for patients with IBD to improve their HRQOL. All care is aligned with Slaintecare. Long-term this will also improve management of patients with IBD at a satellite community level, avoiding both unnecessary ED and GP presentations and ensuring appropriate use of resources nationally.
