GP referrals to TB services Helen Durkan Lead TB Nurse

Number of cases from 01/01/2014 to 31/12/2014 Clinic Number of cases Mile End Hospital 168 Newham Chest Clinic 197 Whipps Cross University Hospital 102 Grand Total 467

Who not to refer to TB services Routine BCG vaccinations Occupational Health Screening Patients who say they have been in contact with ‘someone’ who has TB.(LTBI) GP’s need to get details of the Index case LTBR has the names of all patients in London who have been diagnosed with TB All TB clinics will organise contact tracing Be mindful if patients are asked to be screened it may not be necessary If unsure call TB service for advice.

Who to refer to TB services Remember one third of the worlds population has been exposed to TB Any person who has had a cough for over three weeks MUST have a chest x-ray Send sputum's for AFB’s if patient has a productive cough.

Extra Pulmonary TB Always remember that not all TB is pulmonary. 50% of patients present with signs and symptoms of extra pulmonary TB. Enlarged lymph nodes in neck, groin, armpits THINK ? TB TB bowel, meningitis, uterine, eye, skin, any part of the body. Refer to TB services as well as other services.

Spinal TB

Nine months of TB symptoms White middle class girl Living in Tower Hamlets Seeing her GP for 9 months Cough TB was not considered as a differential Her Chest x-ray showed otherwise.

Abnormal Chest x-ray

LTBR numbers of non PTB cases with the longest delays Number of days delay pulmonary cases number of cases 1 3 2 5 6 7 10 22 24 27 28 35 36 61 73 106 158 No data 12 LTBR numbers of PTB cases with the longest delays   49394 49038 50030 LTBR numbers of non PTB cases with the longest delays 41181 96 days 48250 101 days 47689 124 days 47840 194 days 49690 765 days 48555 2001 days 48624

Example of an unacceptable referral