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


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 – need a revised link

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. There are seven TBCBs:

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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 LTBI 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 an element of admin/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 or admin support?

Yes.

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 2015 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?

LTBI monies will be paid to each CCG on a quarterly basis through the financial year. NHS England has the ability to amend or adjust allocations if satisfactory progress is not being made throughout the financial year and that adjustments to quarterly allocations reflect actual activity of 50% or above as per CCG plans.

Do CCGs have a choice about LTBI testing analysis laboratory providers?

A national NHS procurement exercise has was carried out and LTBI testing analysis laboratory providers for each TB Control Board area appointed to a national framework.

These laboratory 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. This was operationalised with the lead CCG contracting with the laboratory provider (via the NHS Standard Contract) within the national framework. CCGs, as with other services, make the decisions as to which providers to commission from. However, providers not appointed through the national framework are subject to the same quality requirements as those on the framework but have not 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 laboratory 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 agreed through the national procurement process of the agreed 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.

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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) Regulationsinto 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.

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 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. However, PHE and NHS England do expect the laboratories to provide a minimum data set to inform regular activity reporting mechanisms.

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. CCGs can access resources online. Animation resources can be localised for a small fee to the producers.

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 has been rolled out within this time frame.

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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.

Alternatively CCGs can look at alternative models of delivery such as in community and/or secondary care TB services.

Where can I find the National TB services clinical policy and service specification

Please email england.tbprogramme@nhs.net to request a copy of the national TB services clinical policy and service specification.

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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, SystmOne and VISION users. These templates can be activated by any GP across the country. GPs and health care providers who use bespoke medical systems 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.

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

GPs must ensure collection and submission of routine patient registration data to populate the LTBI template. GP practices vary and so each GP is expected to ensure their staff have received the appropriate training 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.

Can the templates be customised or tweaked by the CCGs?

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

GPs should contact their local CCG IT teams for advice.

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What data returns are expected from GPs for this programme?

The expected data returns include some demographic information on eligible patients, LTBI testing invitations, LTBI testing analysis results i.e. positive IGRA. GPs are also expected to supply data on referrals for patients with positive LTBI tests to their local TB team care for further evaluation and treatment.

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

How will GPs send data to PHE?

GP data will be submitted/extracted in line with local commissioning support arrangements, so that the relevant commissioning support provider that deals with patient identifiable data for the CCG may also manage this data. Extraction tools and guides have been developed are available upon request to tbscreening@phe.gov.uk.

Key staff from the CSUs/CEGs will be given access to a secure portal by PHE so that they can upload files (csv) onto the PHE web portal. You can request access to the secure data submission portal by sending an email to ltbiwebportal@phe.gov.uk.

How often should LTBI data returns be submitted to PHE?

Monthly.

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How is LTBI data from LTBI programme providers and TB services being collected?

PHE has developed a web-based data entry system that is aimed at being more user friendly for LTBI programme providers. The data will automatically be populated into the national LTBI database where patient records will be consolidated with primary care records.

An excel template is also available to all LTBI programme providers and TB services to enter LTBI information should they opt not to use the web-based portal. To get access please send an email to tbscreening@phe.gov.uk. Users who opt to continue using the excel spreadsheet will have to upload the data as a csv file onto the PHE web portal. You can request access to the secure data submission portal by sending an email to ltbiwebportal@phe.gov.uk.

What other sources of data are used for programme monitoring?

Laboratory/diagnostics providers participating in the programme are required to submit monthly data returns to PHE. PHE has can provide a template with the required data requirements. This can be accessed by emailing tbscreening@phe.gov.uk. Key staff from the laboratories will be given access to a secure portal by PHE to upload files (csv) onto the PHE web portal. Access to the secure data submission portal can be requested by sending an email to ltbiwebportal@phe.gov.uk.

How can CCGs obtain LTBI programme activity data?

Once the database is fully operational, PHE will regularly report back on the national key indicators by CCG and, TB programme providers and TBCB level. In the interim PHE has continued to send quarterly updates to TBCBs and to CCGs through their respective TBCB. For supporting day to day work, CCGs may wish to arrange cumulative data reports from their commissioning support providers. Ideally this function can be synchronised and timed with data returns to PHE e.g. on a monthly basis. These cumulative returns can be used to measure GP activity levels and may aide GP remuneration at the local level. Typically, such activity reports would include the number of new eligible migrants invited, the number tested for LTBI, the number with positive IGRA tests and the number started on and/or completing treatment.

Image showing the suggested data flow to CCGs.

How can participating services identify eligible patients?

In primary care eligible patients are usually prospectively identified through new patient registration. To retrospectively identify patients, PHE holds Flag4 data from NHS digital for the purpose of supporting CCGs to identify eligible patients. Flag4 data is a list of all new registrations born outside the UK. Since CCGs are not permitted to view or receive Patient Identifiable Information they will need to nominate a person to handle the data on their behalf.

Designated nominees will be:

  • In charge of liaison with the PHE screening team about data sharing agreements
  • Point of contact for end users within the CCG area
  • In charge of supplying data to all end users within the CCG area
  • Making sure the data is used for agreed purposes as per local and national Information Governance guidance

Depending on local arrangements, designated nominees could be from CSUs, TB service nurses, GP federations, GPs or anyone that has permission to view PII within the CCG.

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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 TB services care records. This will enable identification of the proportion of patients with LTBI who receive appropriate treatment. It will also allow monitoring of adverse reactions to treatment.
  • To allow matching of this data to the national enhanced TB surveillance system (ETS). Matching LTBI data to ETS will identification of the proportion of patients with LTBI who develop TB as well as their clinical outcome. This is important for evaluation of the programme.

While the NHS number is an important identifier, PHE requires 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 by PHE. 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 circumstances and local use of Flag4 data. The template covers a data sharing agreement between GPs and commissioning support providers. It details how personally identifiable data (PID) 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. No patient identifiable information is shared outside of this agreement. GPs would still be responsible for complying with all other relevant data protection laws.

If you have further questions regarding Information Governance issues, 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 the patient how their data will be used. The leaflet can be found at the LTBI guidance website.

GPs can record patient dissent (opt-out) to share data on the GP system template. The data for these patients will then be shared with PHE, but anonymised (the extraction tools provide this function for patient records with an opt-out READ code).

If patients choose to opt-out and do not want their anonymised data to be shared with PHE, they can write to the address provided on the leaflet and request their information to be deleted from the LTBI database. This means that patients will be opting to exclude their information because data collection has already occurred (as described above [link to section], collection of data on LTBI is permitted under Regulation 3 of The Health Service Regulations 2002).

Has PHE obtained an Information Standard for this programme?

PHE has obtained an Information Standard for mandatory data collection by the Standardisation Committee for Care Information (SCCI) for the national LTBI programme. It can be found on the HSCIC SCCI web pages. The Information Standard Notice can be obtained on request by emailing tbscreening@phe.gov.uk.

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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 the patient information leaflet available in multiple languages?

PHE and NHS England provide the information leaflet in multiple languages. Please check the NHS and PHE guidance websites for further information and updates.

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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