1. GP referrals to TB services
Helen Durkan
Lead TB Nurse

2. 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

3. 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.

4. 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.

5. 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.

6. Spinal TB

7. 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.

8. Abnormal Chest x-ray

9. 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

10. Example of an unacceptable referral