NHS England hopes to find 50k untreated hepatitis C patients in GP records

A three-month pilot programme will search GP records in the hope of finding 50,000 patients with hepatitis C who are not receiving treatment.

The pilot will launch this autumn, as part of NHS England’s goal to eliminate hepatitis C as a public health issue by 2025.

In total, an estimated 81,000 patients still live untreated with the virus in England but a recent UKHSA report determined that 50,000 of these may be traceable via GP records because of historic risk factors.

NHS England, in collaboration with MSD, will use Patient Search Identification (PSI) software and EMIS Pathway to search an estimated 300,000 primary care records for patients who:

• have a coded hepatitis C virus positive test, but no treatment record, and;
• those with at risk factors, such as intravenous drug use, blood transfusions or organ transplantation before 1992. 

Once an at-risk patient has been identified, one of the seven Operational Delivery Networks (ODNs) signed up to participate in the programme will invite the patient for a review, screening and – if indicated – treatment.  

GP practices will be asked to share the relevant primary care data with specialist secondary care teams within the local ODN.

EMIS clinical director Dr Ian Wood said that ‘at time when primary care is enormously overstretched with both a workload and workforce crisis, it was critical that any new technology aiming to reverse and spearhead this did not exacerbate the capacity issue.

‘The pilot aims to address this gap. It realises the value and power of primary care data, combined with EMIS-X Analytics, in identifying cohorts of patients across a region who might benefit from an intervention.

‘This is a challenge that can be tackled well in multiple healthcare settings, so rather than keep these lists within the GP practice, all the necessary data permissions and safeguarding is in place to share with the most relevant healthcare team that can best meet those patients’ needs.

‘It doesn’t have to be the GP – working together across the healthcare industry we can get the best care to the right patients in as efficient a way as possible.’

Commenting on the importance of screening using primary care records Dr Stuart Flanagan, consultant physician of HIV and BBV Medicine, said: ‘Patients at risk from Hepatitis C within primary care are especially hard to reach. But it’s vital that we do. 

‘The virus can be asymptomatic for decades with many patients often unaware that they have the condition until it’s developed into far more serious, more difficult to treat conditions, and even fatal illnesses such as cirrhosis, liver disease or cancer. 

‘Combine this with there still being stigma attached to the virus, which means some patients may not feel comfortable sharing parts of their current or past lifestyle with their GP, and you’ve got a big hurdle we need to overcome.’

Dr Flanagan who works at the Mortimer Market Centre in London and is the Hepatitis Lead for Central and North West London NHS Foundation Trust, added: ‘We still don’t know the true scale of people living with this condition. The work that has gone into developing an algorithm and the software to identify patients at risk is a vital piece of work. It will help save lives.’

According to data from NHS England, 10-40% of people who have untreated hepatitis C will develop cirrhosis of the liver. One in five people with cirrhosis will develop liver failure and a further one in 20 develop liver cancer. 

Kuldip Sembhi, national hepatitis C virus elimination programme Lead for MSD, said: ‘Increasingly, primary care records are playing a significant role in improving population health. This is yet another occasion when insight from primary care can make a significant contribution to positively changing the health and lives of so many people.’

According to UKHSA, hepatitis screening rates declined within primary care by 36% during 2020 due to Covid-19 restrictions.