1. Weston Outreach Clinic

2.  GP concern re numbers accessing tx  Patient group/local drug services pressure  Poor attendance Weston patients  Disadvantaged group poor access to transport  Nationally patients with hx IVDU prone to DNA  Flow from diagnosis- treatment woefully inadequate { Prof Graham Foster }

3.  Connects screening agency with treatment provider Drug workers screening patients can see the progress of people they have identified and can discuss patients failing to engage with treatment. Provides an incentive for drug/healthcare workers to refer. Drug workers can more easily act as advocates for their clients with better access to treatment provider Treatment provider can obtain background information on patients and identify how best to approach individual problems.

4.  Easy affordable access for patients without own transport avoids parking difficulties for patients with transport  Volunteer service to give lifts for unavoidable visits  Less time consuming no need to spend large part of day waiting for or on Public transport/navigating around Hospital [hour plus on Bus Weston to Bristol]  Drug workers available to discuss problems and give advice on how to explain difficulties  Specialist Nurse better placed to explain side effects / problems associated with treatment to patients other care providers  Call from drug workers on day of appt

5.  HCV PCR positive patient identified by GP or Addaction  Referral made to Hepatology BRI and appt allocated  Patient seen by specialist nurse history, blood tests, examination carried out, fibroscan, Psychiatric referral,USS requested as appropriate  Nurse sees patient to discuss treatment options and review results /investigations. Any significant problems discussed with Consultant at MDT beforehand

6.  Treatment started if no significant contraindications and patient prepared to start  Patient seen 2-4 weekly depending on response Medication delivered to Addaction. Supporting meds picked up from Boots chemist nearest patient  Follow up 12 weeks and one year post tx if successful discharge to GP  Treatment failed /patient wishes to defer treatment reviewed 6 monthly

7.  Initial £12000 from local health authority to cover set up costs  0.2 WTE Specialist Nurse initially now 0.1 WTE due to long term sickness providing fortnightly clinics  Liaison Psychiatry offer appointments on request  Investigations/drug costs covered by BRI Hepatology Dept.  Hepatology Dept. covers administrative costs

8. MonthNew Attendances Follow/Up AttendancesTotal Attendances Apr-13 31215 May-13 21416 Jun-13 31215 Jul-13 41721 Aug-13 279 Sep-13 91726 Oct-13 91827 Nov-13 023 Dec-13 021 Jan-14 22224 Feb-14 12324 Mar-14 22224 Apr-14 62026 May-14 016 Jun-14 11011 Jul-14 017 Aug-14 21618 Sep-14 52328 Grand Total 51310361

9.  22 patients on current standard of care in since April 2013 18 months  2 of the 22 dropped out of treatment  1 patient started on Expanded access programme with Sofosbuvir  1 patient awaiting confirmation from NHS England  1 patient died  29 deferred treatment either to wait for NICE guidance or they preferred monitoring to treatment

10.  48% of new patients seen proceeded to treatment so double number patients referred starting treatment  Overall DNA rate 26% difficult to compare to previous DNA rate for Weston Patients  Figures from NHS Scotland indicate only 20% people get as far as specialist care a quarter of these receive treatment

11.  Increase frequency Weston Clinics ?  Outreach clinics in areas with high levels HCV/deprivation remote from central Hospitals?  Closer contacts with drug treatment Agencies {BDP Compass Healthcare]?  Implications of high drug costs but less significant side effects in clinic structure