The programme

An innovative and sensitive pathway based around a diagnostic test to help GPs make the difficult discrimination between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) has been developed. Using guidelines from a pilot programme in York, we have implemented the pathway in nine Clinical Commissioning Groups (CCGs) and plan to implement the guidelines in eight more with the aim of influencing 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 per cent of the population, half of whom will consult their GP with 79,000 new cases diagnosed each year. Inflammatory bowel disease (IBD) occurs much less commonly, being seen 3 per cent 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 new Faecal Calprotectin Care Pathway across the Yorkshire and Humber footprint and wider.

An evaluation of the pathway has been completed and the results show:

  • A reduction in referrals for colonoscopy by 25%
  • A reduction in gastroenterology IBS-related first appointments by 33%
  • A £2.5million return on investment to the system
  • An increase in the number of people identified early with IBD
  • Improved GP confidence in managing IBS in primary care
  • Improved 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 the pathway across the whole Yorkshire and Humber region
  • Provide assistance to GPs in implementing the programme
  • Offer recommendations to NICE regarding the potential for changing guidelines

Impact

A full health economic evaluation has been conducted that demonstrates:

  • Routine use of the proposed guidelines in general practice has reduced inappropriate referrals for colonoscopy by 25 per cent and gastroenterology IBS-related first appointments by 33 per cent
  • Patients with IBS receive more timely care, closer to home and have better management of their condition
  • Patients with IBD  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
  • £2.5 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.