Frequently Asked Questions

Frequently asked questions to support the rollout of new entrant latent TB testing (LTBI) and treatment programme for GPs and CCGs.

Commissioning

Data returns

Information governance

Communication

NICE guidelines


Commissioning

Where can I find more details on what the lead CCG responsibilities are, and the scope of the lead CCG accountability and responsibilities?

This is set out in  TB commissioning guidance

What would the lead commissioner responsibility be to CCGs that have not put in a bid for NHS England funding for testing and treatment given that they may fall within our geographical area?

The nature of the responsibilities covered by the role of the lead CCG is for local agreement with other CCGs. The commissioning guidance referred to above includes possible roles for the lead CCG. The role could include responsibility for commissioning of latent TB infection (LTBI) testing for other CCGs, regardless of whether these CCGs have received NHS England funding for LTBI testing.

Is there a TB Control Board (TBCB) wide clinical lead for the LTBI testing and treatment programme?

It is important to have clinical leadership and champions to promote the local implementation for LTBI testing and treatment. This could be on a locality (e.g. CCG, local authority or provider) level or wider (e.g. TBCB) and the exact details would be for localities/ TBCBs to decide.

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Whose responsibility is it to ensure adequate capacity with treatment providers? Could this be ensured via acute commissioning arrangements, or would this fall to the lead CCG?

Agreeing capacity with treatment providers is part of CCG commissioning responsibilities. Whether this is carried out by the lead CCG or other CCGs depends upon local arrangements. The TBCB may also wish to work with CCGs to reach a common understanding on treatment capacity. The agreed roles should be defined as part of local agreements.

The lead CCG may need to increase the staff resource required to take on the responsibilities of a lead CCG. Will NHS England provide the funding for this and how will this be agreed?

CCGs should consider the staffing implications for a lead CCG as part of locally agreeing lead arrangements. The majority of Latent TB plans submitted by CCGs and partners included project management support and the support for the lead CCG could be part of that.

Can LTBI plans include implementation support i.e. project manager?

Yes for the implementation phase of the programme.

Has a standard GP contract or SLA been developed which can be used by CCGs with their GPs?

Yes. A template local service specification for GPs was circulated in October by PHE to TBCB TB leads and managers for further cascade to CCGs. This template can be amended for local needs and used in conjunction with the NHS Standard Contract. To receive a copy of the template, please send a request to tbscreening@phe.gov.uk.

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Will local CCGs require a contract with their local TBCB for their LTBI plans?

No, but the TBCB has an important local oversight role in relation to TB activities. The relationships between TBCBs, CCGs, NHS England and other partners are important and clear agreements on how each stakeholder will operate will be highly beneficial.

Why can’t GP incentives be done through a DES?

Directed Enhanced Services (DES) are used for a limited, specified range of priorities and are most suitable for issues that require addressing by all CCGs. Given that the focus of the TB Strategy is on areas with high incidence of TB, local incentives schemes are considered to be appropriate.

How will the LTBI plans monies be paid to the lead CCG, monthly or lump sum?

A lump sum will be paid to the high incidence CCGs for relevant periods in 2015/16. The precise arrangements for future years will be advised early in 2016.

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Do CCGs have a choice about LTBI testing providers?

A national NHS procurement exercise has been completed and LTBI testing analysis providers for each TB Control Board area appointed to a national framework.

These providers have agreed to provide LTBI laboratory test analysis and reporting services for a fixed price per test, including transport of the sample, and work to a set national quality specification. For this to be operationalised, local CCGs need to contract (via the NHS Standard Contract) with the relevant framework providers for their area. CCGs, as with other services, make the decisions as to which providers to commission from. However, providers not appointed to the national framework are not subject to the same quality requirements as those on the framework, nor have they been through the same rigorous selection process, as those on the national framework. It is therefore considered to be in the interest of CCGs to utilise providers on the national framework. CCGs using other providers would need to take the requirements of the Procurement, Patient Choice and Competition) Regulations into account in reaching their decision.

The funding for laboratory services for LTBI testing made available by NHS England to CCGs is based on the costs of the relevant providers on the framework. If a CCG chose to use a more expensive provider not on the framework, they would need to meet the additional cost from their own resources.

Would there be a financial risk sharing if LTBI testing activity were to go above agreed activity and therefore local budgets?

Funding provided for LTBI testing by NHS England are based on plans submitted by CCGs and partners. The management of LTBI testing activity, and the funding implications of additional activity, are matters for local arrangements. Additional national resources are not available where planned activity is exceeded.

From a contract management aspect is the lead CCG expected to agree meetings with providers to look at performance against KPIs, finances and other aspects that affect testing holistically? Is this an oversimplification?

The precise nature of the responsibilities is for local agreement. The role of contract management of LTBI testing providers is similar to other ranges of CCG contract management responsibilities.

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Will the laboratories provide data to the commissioners of the number of tests carried out by named practices and also the results so we have triangulation of claims?

The service specification for LTBI testing providers includes minimum data requirements.

It is for CCGs to agree with providers on additional information requirements.

Can funding be pooled across CCG’s i.e. advertising?

It is up to CCGs to agree locally how joint costs might be shared. If CCGs do plan to share costs, the CCG that receives the funding should be recharged by the other CCGs.

Is there an expected timeframe when this work is expected to be completed by?

The Collaborative TB Strategy, of which new migrant LTBI testing and treatment is a part, is for 2015-2020, and the programme is being rolled out within this five year horizon. National funding for years beyond 2015/16 will be made as part of wider budgetary decisions by NHS England and Public Health England.

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How will PHE communicate findings to CCGs i.e. uptake of tests?

PHE is implementing a national database system and it is expected that there will be regular reporting at TBCB level. However, requirements on broad operational aggregate data of number of tests, uptake, LTBI positivity and treatment referral should be agreed by CCGs with the relevant commissioning support provider which locally manages data obtained from GP systems. Together, these two data returns will satisfy the reporting requirements.

We have had poor engagement from GPs in the development of our plans. How should we proceed?

GPs are key stakeholders in the local implementation of the national TB Strategy that aims to reduce TB incidence across England. The testing and treatment of LTBI patients in primary care critically depends on the engagement of GPs. In many areas, identifying and closely working with a GP champion, and close engagement with the CCG and the Local Medical Committee has been helpful, as has been the provision of funding, where appropriate, for additional responsibilities, together with good training opportunities.

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Data returns

How will GPs collect information on LTBI testing and treatment?

GP practices are responsible for collecting and entering screening data into their GP system. An LTBI template is now available for EMISWeb and SystmOne users. These templates can be activated by any GP across the country. GPs and health care providers who use other medical systems such as Vision or have no access to GP systems, such as the TB nursing service, will enter information via a web-based system developed by PHE. These providers should contact PHE tbscreening@phe.gov.uk to arrange access. We are looking to develop more templates for other GP systems, such as Vision, in the near future.

In the early phase many eligible patients will be identified through new patient registration. GPs will collect routine patient registration data as well as populate the LTBI template. GP practices vary and so each GP is expected to train their staff on how to do this.

How can GPs activate and access these templates?

Instructions on how GPs can activate these templates will soon be made available on the PHE guidance website.

A quick guide on how to activate the EMIS Web LTBI template is already available in appendix E of the LTBI guide for clinicians and commissioners.

Furthermore, the developers of the EMIS Web LTBI template, Clinical Effectiveness Group, Blizzard Institute, have produced an LTBI template guide.

Can the templates be customised or tweaked by the CCGs?

The templates are designed to collect data uniformly across all GPs. Changes to templates should be limited to name & logos. Changes should not be made to the data variables being collected.

GPs should contact their local CCG system support team on how to customise their templates.

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What data returns are expected from GPs for this programme?

The expected data returns includes demographic information on eligible patients, screening invitations, LTBI testing analysis results i.e. positive IGRA. GPs are also expected to supply data on referrals for patients with positive tests to secondary care for further evaluation.

A full variable list of required data fields can be requested by sending an email to tbscreening@phe.gov.uk

How will GPs send data to PHE?

It is planned that GP data will be extracted in line with local commissioning support arrangements, so that the relevant commissioning support provider that deals with patient identifiable data for the CCG also manages this data. Key staff from the CSU/CEGs will be given a CyberArk account by PHE so that they can upload files (cvs) onto the PHE secure server.

How often should LTBI data returns be submitted to PHE?

Monthly.

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How is LTBI data from secondary care being collected?

A temporary web-data entry portal is now available to all secondary TB services to enter LTBI information. To get access please send an email to tbscreening@phe.gov.uk.

PHE is developing a more user friendly web-based data entry system for secondary care. The data will automatically be populated into the national LTBI database where patient records will be consolidated with primary records.

Is it possible for secondary care providers to send LTBI data electronically to PHE?

On occasion, and after detailed discussions with PHE and ensuring standardisation of variables, this may be possible. If you are considering sending PHE electronic files please contact tbscreening@phe.gov.uk

How can CCGs obtain LTBI programme activity data?

Once that database is fully operational, PHE expects to regularly report back on the key indicators nationally and at TBCB level (providing some breakdowns by CCG). In the interim and for steering day to day work, CCGs may wish to arrange cumulative data reports from their commissioning support providers .Ideally this function could be synchronised and timed with data returns to PHE, e.g. on a monthly basis These cumulative returns could be used to measure GP activity level and may initially aide GP remuneration. Typically such activity reports would include the number of new eligible migrants, the number tested for LTBI, the number with positive IGRAs and the number started on treatment.

Image showing the suggested data flow to CCGs.

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Information governance

Why is Personally Identifiable Data (PID) being collected for this programme and is the NHS number not enough?

PID is being collected for the following reasons:

  • To de-duplicate records to ensure accuracy of data being received.
  • To ensure the integrity of the clinical care pathway by consolidating primary care and secondary care records. This will enable us to identify the proportion of patients with latent TB who receive appropriate treatment. It will also allow monitoring of adverse reaction to treatment.
  • To allow matching of this data to the national enhanced TB surveillance system (ETS). Matching LTBI data to ETS enable us to identify the proportion of patients with latent TB who developed TB as well as their clinical outcome. This is important for evaluation of the programme.

While the NHS number is an important identifier, PHE needs additional identifying information to ensure records are accurately processed (de-duplicated, consolidated and matched) and to be able to match records without NHS number

Has a data sharing agreement been developed?

Yes. A template of the data sharing agreement has been developed and was circulated by PHE in October. If you would like a copy please email tbscreening@phe.gov.uk.

How should the data sharing agreement template be used?

The template should be used as guidance to facilitate the transfer of data from GP systems and can be amended for local circumstance. The template covers a data sharing agreement between GPs and commissioning support providers. It details how personally identifiable data (PIDs) will be extracted from GP systems and sent to PHE.

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Do GPs need patient consent to send PID to PHE?

PHE has obtained approval to receive and process confidential patient information without first obtaining patient consent for the LTBI programme under Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002 (as made under Section 60 of the Health and Social Care Act 2001 and amended by Section 251 of the NHS Act 2006). This legislation provides for the common law duty of confidentiality to be set aside to allow confidential patient information collection without patient consent to be processed for purposes related to “communicable disease and other risks to public health”. This approval means that GPs will not be in breach of common law duty of confidentiality when they share the requested LTBI data with PHE. They would of course still be responsible for complying with all other relevant data protection laws.

If you have further questions regarding IG please send them to tbscreening@phe.gov.uk

What if a patient does not want to share their LTBI information with PHE?

GPs satisfy ‘fair processing’ by giving patients a copy of the patient information leaflet which tells them how their data will be used. Once patients are aware of this, they can write to the address provided on the leaflet and request their information to be deleted from the LTBI database. This means is that patients will be opting to exclude their information because data collection has already occurred. The leaflet can be found at the LTBI guidance website.

Has PHE obtained an Information Standard for this programme?

We are pleased to report that Latent tuberculosis testing treatment programme for new migrants has obtained an Information Standard for mandatory data collection by the Standardisation Committee for Care Information (SCCI). Once the notice is published it can be found on the HSCIC SCCI web pages.

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Communication

Will there be a regular update on the LTBI screening programme including FAQs?

Yes. A regular update on the TB strategy is available via the PHE website page:

New information will also be updated on:

In addition both NHS England and PHE send regular emails to relevant stakeholders. If you wish to be added to the email contact list please contact jointly england.reducingprematuremortality@nhs.net and tbscreening@phe.gov.uk

Is Is the patient information leaflet available in multiple languages?

Patient leaflet’s for LTBI screening are available in 11 languages and are available online on the gov.uk website. Hard copies of the English version are available free through Prolog, by calling 0300 123 1002, quoting product reference 3168761, or on-line at www.orderline.dh.gov.uk.

Details of other language leaflets and how hard copies can be ordered will be available soon.

What communication material for primary care, patients and communities has been developed centrally and how can CCGs draw on this?

Details are available on the PHE website.

Are there any bespoke training courses (online and otherwise) that could be used for training primary care staff and GPs? Are there any regional or national events/meetings planned to support this work?

A range of training materials are being made available via the PHE website. These will add to those already available for health care professionals on the TB Alert website and via the RCGP’s Online Learning course for TB. Where local training events are arranged, it may be possible for members of the national NHS England/PHE team to attend and support the event, dependent upon other commitments.

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NICE guidelines

The updated NICE guidance on Tuberculosis was published January 2016. How does this impact the national LTBI programme?

Clinicians and commissioners should take the 2016 NICE Guideline on TB, including the extension of age groups for latent TB testing, into account when either planning services or care for an individual patient. However, the funding associated with the ‘Collaborative TB Strategy for England’ for testing and treatment of latent TB is restricted to 16-35 year old new entrants who have arrived in the UK within the past five years (as this is the highest TB burden group).The commissioning of services in relation to testing and treatment for other age groups, and the funding of these, is a matter for local consideration by CCGs.

The guideline recommends Mantoux testing as the initial diagnostic test for latent TB infection in people who have recently arrived from a high‑incidence country. How does this affect the national LTBI programme?

In relation to the type of latent TB test to be used, NICE has confirmed that LTBI testing and treatment programmes (such as that detailed in the ‘Collaborative TB Strategy for England’ for new entrants) were out of scope for the 2016 NICE Guideline and that IGRA tests should continue to be used for programmatic LTBI testing. This position is also consistent with the 2016 NICE Guideline that recommends using IGRA to test large numbers of people in an incident setting (ref 1.2.3.2).

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