- GPs play a key role in spotting tuberculosis (TB) cases.
- Delay in diagnosis is a key concern in identifying and treating TB.
NICE guidance and PHE/NHS strategy
Guidance issued by NICE identifies the key role played by GPs and other primary care staff at the front line of TB diagnosis. It aims to increase awareness among health professionals, in order to support early diagnosis and minimise deaths from the disease.
The guidance follows the publication of a joint strategy on TB from Public Health England (PHE) and NHS England which outlines 10 areas for action, one of which is improving access to services and ensuring early diagnosis.
Role of GPs
The incidence of TB in the UK remains high when compared with other western European countries, with some London boroughs classed as high incidence by the World Health Organisation. High risk groups include people living in more deprived areas of the country, the unemployed, those with drug or alcohol problems, homeless people or those who have spent time in prison.
80% of patients who receive treatment are cured, which means early diagnosis is essential in preventing significant morbidity and mortality.
Avoiding diagnosis delays
Of the delayed diagnosis cases seen in recent years by the MDU, many were of spinal TB, where patients were treated symptomatically with pain relief for some time before the diagnosis was made.
In other cases, patients were initially diagnosed as having lung cancer but were later shown to have TB.
The symptoms that patients who have TB can present with are many and varied, and can mimic other illnesses. This can make identification of this infection difficult.
The MDU advises clinicians, particularly those in high risk areas such as some London boroughs, to actively consider TB as a differential diagnosis.
- Familiarise yourself with the NICE guidance and advice from your local TB multidisciplinary team.
- Consider TB in your differential diagnosis, particularly among high risk groups (see above) and when a patient's symptoms fail to respond to initial therapy.
- Seek a specialist opinion if patients fail to respond to treatment.
- Make sure patients understand when to seek further advice if their condition doesn't improve, and record that this safety netting advice has been given.
- Keep good records of significant negatives as well as positive findings in the history and examination.
This guidance was correct at publication 01/11/2017. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.