Pay GP practices to screen high-risk patients for TB, NICE urges
GP practices should be incentivised to screen and vaccinate people at high risk for tuberculosis infection, NICE experts have said.
In new guidance released today, NICE called for practices to help increase uptake of the BCG vaccination and tuberculosis (TB) testing in vulnerable groups in a bid to tackle escalating rates of TB, particularly in deprived parts of the country.
The guidance calls for commissioners to ‘consider financial incentives for practices for identifying eligible groups for BCG and TB testing’.
These include new entrants to the UK, but the guidance also highlights that vulnerable migrants who have not previously been checked should be tested for latent TB ‘regardless of when they arrived in England’.
It adds that ‘people born in countries with an incidence of more than 150 per 100,000 per year should be made a priority for latent TB testing when they arrive here’.
The call comes a year after NHS England and Public Health England launched a nationwide strategy to get GPs to carry out 'targeted TB screening and education' in new registrants, promising £1.5m over five years to set up new TB control centres, although there were few details on whether practices would be funded.
Among other recommendations, the NICE guidance also calls for greater efforts to find active cases of TB in high-risk communities.
It also recommends wider treatment for latent TB – which it says should be extended from only treating those under 35 years of age to treating anyone up to 65 – as the course is shorter and easier to stick to than treatment for subsequent active, infectious disease.
Professor Andrew Hayward, chair of guidelines advisory panel, said: ‘We know what needs to be done to address the problem of TB in England; identify cases earlier, support patients through prolonged treatment and invest in co-ordinated services which are resourced to engage with socially complex cases.
‘If rigorously applied the recommendations in this guidance will help to minimise the spread of infection, prevent the development of drug resistant disease and reduce the numbers of TB cases in the UK.’
NICE Guidelines - Tuberculosis
BCG vaccination – encouraging uptake among infants, older children and new entrants
Deliver the following interventions in primary care settings to improve uptake of BCG vaccination in people from eligible groups (as outlined in the Green Book):
- education and support for practice staff, including raising awareness of relevant guidelines and case definition for at-risk groups, and promoting BCG and TB testing in eligible groups;
- Incorporating reminders for staff (prompts about eligibility for BCG) on practice computers (for example, embedded in medical records);
- Consider financial incentives for practices for identifying eligible groups for BCG and TB testing;
- Reminders (‘immunisations due’) and recall (‘immunisations overdue’) for people who are eligible for vaccination or for parents of infants and children who are eligible, as outlined in the Green Book. (This could include written reminders, telephone calls from a member of staff or a computerised auto dialler, text messages or a combination of these approaches.)
Opportunistic case finding – new entrants from high incidence countries
Primary care services should support local, community-based and voluntary organisations that work with vulnerable migrants to ensure they:
- register with a primary care provider
- know how to use NHS services
Healthcare professionals, including primary care staff, responsible for testing new entrants should test all vulnerable migrants who have not previously been checked. This is regardless of when they arrived in England. People born in countries with an incidence of more than 150 per 100,000 per year should be made a priority for latent TB testing when they arrive here.