The programme

An innovative and sensitive new test to help GPs make the difficult discrimination between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) has been identified. Using guidelines developed from a pilot programme in York, we will aim to implement the guidelines in eight more pilot sites, whilst developing a robust evaluation process, which will impact on future NICE guidance.

Why?

Lower gastrointestinal symptoms are very common. They are challenging both for patients and GPs because different diseases can cause them. Irritable bowel syndrome (IBS) affects 10-20% of the population, half of whom will consult their GP. 79,000 new cases are diagnosed each year. Inflammatory bowel disease (IBD) occurs much less commonly, being seen 3% of the time.

Because distinguishing IBS from IBD is difficult as many as 19 out of 20 patients are unnecessarily referred to secondary care while for other patients diagnosis is delayed. This programme aims to implement the York model at scale while also developing robust evaluation which will impact on future NICE guidance.
If successful, this project could

  • Reduce referrals for colonoscopy by 25%
  • Reduce gastroenterology IBS-related first appointments by 33%
  • Deliver a £1.4million return on investment to the system
  • An increase the number of people identified early with IBD
  • Improve GP confidence in managing IBS in primary care
  • Improve patient experience through safer and quicker diagnosis and treatment decisions

How are we helping?

Calprotectin is a stable protein released from white blood cells during inflammation. When the lower gastrointestinal tract is inflamed, elevated levels of calprotectin are detected in the stool. A normal faecal calprotectin (FC) strongly predicts for IBS and a raised FC increases the likelihood of IBD.
As part of this programme we will:

  • Deliver a pilot in eight different CCGs
  • Provide assistance to GPs in implementing the programme
  • Offer recommendations to NICE regarding the potential for changing guidelines

Expected impact

  • Routine use of the proposed guidelines in general practice will reduce referrals for colonoscopy by 25% and gastroenterology IBS-related first appointments by 33%
  • Patients with IBS will receive more timely care, closer to home and have better management of their condition
  • Patients with IBD will access an earlier referral and receive expert opinion and management of their condition
  • Patients with suspected cancer will access timely and urgent expert opinion
  • Patients requiring colonoscopy will access timely appointments
  • £1.4 million return on investment to the system per year.

Next Steps

We are implementing the pathway across any interested CCGs, with the aim of spreading the pathway across the region and nationally. During this time we will develop a robust evaluation tool followed by further implementation across Yorkshire and the Humber.