Hepatitis B (HBV) is a blood borne virus which can cause progressive liver damage, often leading to cirrhosis. Approximately 325,000 people are infected within the UK. HBV is known to be under-diagnosed so testing is recommended as it is often initially symptomless, yet significant liver damage can still occur and the virus is still highly contagious.
King’s College Hospital’s (KCH) local boroughs are Lambeth and Southwark, where up to 20% of people are from countries in the regions of Asia and Sub-Saharan Africa with more than 8% incidence of Hepatitis B.
The aim of the project, led by Teresa Bowyer, was to develop a specialist, nurse-led GP practice based viral Hepatitis service within Lambeth/Southwark. Project outcomes were:
- A nurse-led service was set up in 2 GP practices.
- Good working relationships were developed with GP practice teams.
- One GP practice was keen to work with Viral Hepatitis Services on further initiatives.
- South London Clinical Commissioning Group considering a new community based Viral Hepatitis Nurse role.
- The percentage of patients rating their care as ‘very good’ was increased from 78% to 86%.
- Of those seen at their GP practice, 93% wanted to continue to be seen there by the specialist nurse.
Information posters to advertise the new service of testing for Viral Hepatitis
An operational guide outlining the agreed processes of the clinics
Two clinics in Southwark and Lambeth
‘Maria’ has been under review at KCH due to her chronic Hepatitis B, which has the potential to cause cirrhosis in up to 30% of patients and liver cancer in 5 to 10% of patients. Following a biopsy, we were able to determine that Maria would not require medication as she had only very mild fibrosis and (mild) active inflammation, with no other abnormalities.
I was pleased to be able to provide such continuity of care for Maria over the year. It was rewarding to be able to see her through the process of the biopsy. She was very grateful for the individual care she received. Moreover, as her GP was managing her anaemia, it is also an excellent example of Primary and Secondary care teams working together in a collaborative, patient focused way.
Maria’s case demonstrates how seamless care can be achieved when transferring care from secondary care to a community based nurse led clinic under consultant supervision. It also demonstrates that quite complex patients can be successfully managed at a GP practice by a specialist nurse. In Maria’s case I was able to help free up valuable secondary care resource for other patients who may need more specialist management.Back