Transcript No Slide Title

British Society of Gastroenterology
Care of patients with
Gastrointestinal Disorders:
A Strategy for the Future
14th March 2006
British Society of Gastroenterology
Launch of Strategy Document
Professor Elwyn Elias
President of the BSG
Welcome
British Society of Gastroenterology
Launch of Strategy Document
Dr Mike Hellier
Chair, BSG Strategy Group
What is Gastroenterology?
Gastroenterology is:-
Oesophagus
Stomach
CANCER
Liver / Pancreas
Bowel
GI Cancer is the commonest cause of cancer death
4
Gastroenterology is:-
Hepatitis
Cirrhosis
JAUNDICE
Alcoholic liver disease
Gallstones
Liver disease kills more women than Ca cervix
5
Gastroenterology is:-
BLEEDING FROM THE BOWEL
Acute GI bleeding has 10% mortality rate
6
Gastroenterology is:-
Acid reflux
INDIGESTION
Dyspepsia
Ulcers
20 – 40% of population affected
7
Gastroenterology is:-
Infective
Ulcerative Colitis
DIARRHOEA
Crohn’s
Irritable Bowel
Syndrome (IBS)
10 – 20% of population affected by IBS
8
©
Anatomy of the gastrointestinal tract
9
Gastrointestinal Disorders
Constitute a huge
burden of disease
to society
10
Gastrointestinal Disorders
COST SOCIETY:
£7.18 Billion in non NHS costs
£1.4 Billion in NHS costs
A HUGE EXPENSE
11
British Society of Gastroenterology
Launch of Strategy Document
Professor John Williams
Gastroenterology services in the UK
The burden of disease, and the organisation
and delivery of services for gastrointestinal
and liver disorders
A review of the evidence
http://www.medicine.swan.ac.uk/giservicesreview
Topics covered
 Burden of disease
− Incidence; mortality; morbidity; quality of life; geographical
variation; socio-economic factors; costs to society
 Current service provision
− Organisation; workforce; primary care activity; inpatients;
procedures; voluntary sector; costs
 Problems with current provision
− Access; inequalities; waiting lists; patient safety; information
to patients and practitioners; complications of care
 Other drivers for change
− Guidelines; changing incidence; screening and prevention;
genetics; quality assessment
Topics covered
 Delivery of services for patients with
gastroenterological and hepatic disorders
− Developments in service delivery
− Patient perspectives
− Economic burden of GI disease
− Cost effectiveness of GI services
− Information and IT infrastructure
Methods
 Systematic review of the literature, supplemented by additional
papers on incidence, mortality and morbidity (997 references
examined; 936 used)
 Interrogation of routine data sources (Hospital episode statistics;
Office of National Statistics; Office of Population Census and
Surveys)
 Critical analysis of the evidence found
 Grading of the evidence as appropriate, based on NICE approach
 Discussion of key issues with service users
 Wide dissemination to seek feedback, and any additional material
 Final revision of the document, with conclusions
A flavour of the findings…
 Rising incidence of...
− Cancer (oesophageal and colorectal)
− Liver disease (hepatitis C; cirrhosis; alcoholic liver
disease; non alcoholic fatty liver disease)
− Barretts oesophagus; pancreatitis; gallstones;
upper gastro-intestinal haemorrhage; diverticular
disease; coeliac disease; irritable bowel syndrome
 Considerable impact on quality of life
Gastrointestinal Disorders
in Primary Care
For every 9 patients who
consult their GP, one will have
a gastrointestinal problem
Source: OPCS 3rd and 4th National Morbidity Surveys
Secondary Care Admissions
Percentage of hospital admissions for major disease groups,
England, 1998/99-2001/02: based on Finished Consultant Episodes
Ill defined & other
22%
Gastrointestinal
17%
Nervous system
3%
Genitourinary
12%
Eye, etc
4%
Circulatory
11%
Skin, etc
4%
Haematological
4%
Musceloskeletal
7%
External causes
8%
Source: Department of Health Hospital Episode Statistics
Respiratory
8%
OPCS-4 chapter
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Source: Department of Health Hospital Episode Statistics
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Hospital bed occupancy for
gastrointestinal procedures
Total number of bed days for main surgical and endoscopic
procedures by OPCS-4 chapter in England, 2000/01
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Source: ONS (2001)
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Mortality rate (per 100,000)
Mortality from gastrointestinal disorders
All ages
Mortality rates (per 100,000) for major disease
groups, England & Wales, 2000: people of all ages
400
300
200
100
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Mortality rate (per 100,000)
Mortality from gastrointestinal disorders
in the potentially working population
Mortality rates (per 100,000) for major disease groups,
England & Wales, 2000: people aged 15-64
80
60
40
20
0
Cause of death
Source: ONS (2001)
Gastrointestinal cancer
Percentage of cancer deaths, according to site of cancer:
England & Wales, 2000
Kidney
2%
Skin
1%
Other &
unspecified 18%
Gastrointestinal
tract
28%
Brain 2%
Ovary 3%
Bladder
3%
Prostate
6%
Source: ONS (2001)
Lung
22%
Lymphatic tissue,
etc 7%
Breast
8%
Costs to society of gastrointestinal
and hepatic disorders in 2004
 Workforce
− 150,000 person years of working age lost per
annum from premature death (cost £3.2b pa)
− 1.7% of long-term sickness absence (£1.05b pa)
− 20% of short-term sickness absence (£2.9b pa)
 Hospital costs in England £1.44b pa
 Total NHS costs in England £2.4b pa
Source: Lewison G Gastroenterology in the UK: the burden of disease. Wellcome Trust 1997.
Service provision
 There is strong evidence for a shift towards greater
self-management by patients with chronic inflammatory
bowel disease (level of evidence: 1)
 But such patients need support (eg education; rapid
access to specialist services when needed)
 We found no research into the clinical or cost
effectiveness of diagnosis and treatment centres
 Nurses can perform diagnostic endoscopy safely
and effectively, but are not more cost effective than
doctors (1)
Specialisation
 In hospital, patients with GI and liver disorders
should be looked after by specialists (2+)
 Complex surgery for GI and hepatobiliary cancer
should be performed by specialists who operate
on larger numbers (2+)
 There is insufficient evidence to support the greater
concentration of services in tertiary centres without
further research into the clinical and cost benefits,
and disbenefits to other services
Clinical Research
 Much data is available on burden of disease
 There is a lack of high quality research relating to the
organisation and cost effectiveness of services, but
plenty of opinion
 Much more research is needed, to inform policy,
service delivery and organisation
 A more strategic approach to the co-ordination and
funding of research in gastroenterology is needed
(as for cancer, heart disease, elderly etc)
 The UK Clinical Research Collaboration is potentially
a major opportunity
British Society of Gastroenterology
Launch of Strategy Document
Gastroenterology Services
in the UK
The burden of disease, and the organisation
and delivery of services for gastrointestinal and
liver disorders: a review of the evidence
http://www.medicine.swan.ac.uk/giservicesreview
Thanks to
Those who did the work:
Faiz Ali; Ivy Cheung; David Cohen; Gaynor Demery; Richard Driscoll;
Adrian Edwards; Margot Greer; Mike Hellier; Hayley Hutchings;
Barry Ip; Mirella Longo; Stephen Roberts; Ian Russell; Helen Snooks;
Judy Williams; Giles Croft; Ian Frayling; Alistair McIntyre; Roland
Valori; Anne Williams
Many other colleagues who gave us comments and further
information, and the service users who discussed our findings
The British Society of Gastroenterology for funding
British Society of Gastroenterology
Launch of Strategy Document
Professor Alastair Watson
Royal Liverpool University Hospital
GI Cancer
21% of all new cancers in the UK
are gastrointestinal
Breast
Lung
Large bowel
Prostate
Bladder
NHL
Stomach
Melanoma
Oesophagus
Pancreas
Leukaemia
Ovary
Kidney
Body of uterus
Brain and CNS*
Oral
Multiple myeloma
Cervix
Liver
Larynx
Other
Males
Females
0
*central nervous system
10,000
20,000
30,000
40,000
Number of new cases
Cancer Research UK
30
24% of all cancer deaths in the UK
are gastrointestinal
Lung
Bowel
Breast
Prostate
Oesophagus
Pancreas
Stomach
Bladder
NHL
Ovary
Leukaemia
Kidney
Brain & CNS
Head and Neck
Multiple myeloma
Liver
Mesothelioma
Melanoma
Cervix
Body of Uterus
Other
Males
Females
0
10,000
20,000
30,000
40,000
Number of deaths
31
Comparison of survival from colon cancer
Percentage of patients
living for 3 years
USA
Merseyside
Thames
69%
52%
44%
Late diagnosis when the disease is incurable.
Gut 2005;54:268-273
32
British Society of Gastroenterology
Launch of Strategy Document
Professor Elwyn Elias
President of the BSG
Liver Disease
BSG Strategy: Liver Disease
 Overweight and Obesity - Obesity Trends
 Prevalence among U.S. Adults of a Metabolic Syndrome
Associated with Obesity
(Findings from the Third NHANES Survey)
The Centers for Disease Control and Prevention (CDC) estimated
that as many as 47 million Americans may exhibit a cluster of
medical conditions (a "metabolic syndrome") characterised by
insulin resistance and the presence of obesity, abdominal fat, high
blood sugar and triglycerides, high blood cholesterol, and high
blood pressure
34
Hospitalisation for NAFLD
FCE rate of NAFLD of the male population by 10-year age band
45
Rate (per million)
40
35
30
25
20
15
10
5
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
Year Band
15-24
25-34
35-44
45-54
55-64
65-74
75+
Courtesy of Dr P Roderick
35
Nash & Cryptogenic Cirrhosis
C.C.
NAFLD
/NASH
HCV
CIRRH.>50YR
PBC
CIRRH
N
70
50
39
33
AGE
63
49
60
54
FEMALE
49 (70%)
28 (56%)
15 (36%)
33 (100%)
DM or OB
51 (73%)
35 (70%)
11 (28%)
8 (33%)
DM
37 (53%)
21 (42%)
10 (25%)
5 (15%)
MARK OB
33 (47%)
32 (64%)
1 (3%)
5 (15%)
Caldwell SH et al Hepatology 1999; 29 : 664
Mortality trends from liver disease
in England Wales 1950-2000
37
Alcohol consumption 1900-2000
38
Mortality from Alcoholic liver disease in males.
England & Wales 1960-2000
39
Mortality from Alcoholic liver disease in
females. England & Wales 1950-2000
40
Hospitalisation rates for alcoholic liver
disease 1988-2002
FCE rate of ALD of the male population by 10-year age band
Rate (per million)
1400
1200
1000
800
600
400
200
0
1988
1989 1990
1991 1992 1993
1994
1995 1996
1997 1998
1999 2000 2001 2002
Year Band
15-24
25-34
35-44
45-54
55-64
65-74
75+
Courtesy of Dr P Roderick
41
Mortality from Hepatitis C
England & Wales
150
Males
100
Females
50
Total
0
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
Number of deaths
(ICD9 0704-0709)
Mortality due to viral hepatitis (unspecified)
Year
42
Hepatitis C in England
The First Health Protection Agency Annual Report 2005
43
Age specific rates of Laboratory notifications
Hepatitis C in England & Wales
300
250
0-4
5 to 24
200
25-34
150
35-44
45-54
100
55-64
50
>65
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
0
44
Hepatitis C in England
The First Health Protection Agency Annual Report 2005
45
Hepatitis C in England
The First Health Protection Agency Annual Report 2005
46
Hepato-cellular cancer mortality in males
England & Wales 1960-2000
47
Chronic liver disease:
Patients listed for transplantation 2000-2
Alcoholic liver disease
295 (16.4%)
Primary biliary cirrhosis
239 (13.2%)
Hepatitis C cirrhosis
218 (12.1%)
Primary sclerosing cholangitis
149 (8.2%)
NASH/cryptogenic cirrhosis
126 (6.9%)
Hepatitis B
73 (4.0%)
Auto-immune hepatitis
68 (3.8%)
Data from UK Transplant
48
Total number of liver transplants in UK by year
800
700
642
672
669
692
672
689
732
714
636
606
600
500
400
300
200
100
0
1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 20051997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Data from UK Transplant
49
Percentage of total liver transplants that
were less than whole grafts
18
16
14
12
10
split
reduced
8
6
4
2
0
1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 20051997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Data from UK Transplant
50
BSG Strategy:
Epidemiology of Liver Disease
 Non Alcoholic Fatty Liver Disease
 Alcoholic Liver Disease
 Hepatitis C
These are examples of liver diseases which:
 Are on the increase
 Have their highest incidence in the relatively young
 Have a latent period of 10-30 years before they are reflected in
− Waiting list for liver transplants
− Cancer development
− Mortality statistics
51
BSG Strategy: Liver Disease
 Initial screening in primary care
 Defined pathways for referral to secondary care
 Endoscopy etc. according to guidelines
 Multidisciplinary team work (gastroenterologists,
surgeons, interventional radiologists, nurse specialists,
nutritionists, pathologists and intensivists)
 Networking
 Audit data on outcome, efficacy, complications
52
British Society of Gastroenterology
Launch of Strategy Document
Professor Tony Morris
President Elect BSG
Immediate Past Chairman JAG
Endoscopy
A variety of gastrointestinal endoscopes
used to investigate and treat GI diseases
54
Gastrointestinal Endoscopy
Plan of talk
 Problems with the endoscopy service
 Endoscopic workload
 Service improvement programme
 Training and the National Programme
 Workforce developments
 The BSG and endoscopy
55
Problems with endoscopy
 Non standardized training
 Previous poor performance in National Audits





and NCEPOD report
Long waiting lists
Many Government targets
Poor infrastructure and equipment
Increasing workload
Relative shortage of staff
(endoscopists and support)
56
Past and predicted endoscopic workload
% population having an endoscopy
1.2
2003
2008
1
0.8
0.6
0.4
0.2
0
OGD
F Sig
Colon
EUS/ERCP
57
Service improvement programme
 Initiated by Modernisation Agency
 Rolled out throughout England
 Supported by Strategic Health Authority Endoscopy
Leads
 Aimed at:
− reducing waiting times
− improving quality of patient experience
− preparing for introduction of Bowel Cancer Screening
 Introduction of Global Rating Scale
 Acknowledged linkage of service delivery and training
58
Service improvement programme
 Apply demand and capacity process mapping
 Communal waiting lists
 Reduced room downtime (30%) by backfilling lists
 Employ non-medical, trained endoscopists (mostly nurses)
 Validate waiting lists (dead, done, don’t want, don’t need,
moved)
 Reduce ‘Did Not Attends’
 AIM
− all urgent scopes within 2 weeks
− all routine scopes within 6 weeks
 Remove the ‘endoscopy bottleneck’ to achieve the ‘62 day
cancer’ and ‘18 week time to treatment’ targets
59
The Global Rating Scale (GRS) 1
www.grs.nhs.uk
 Developed as part of service improvement programme
 Devised by Dr R Valori (National Endoscopy Lead)
and endoscopy colleagues on behalf of the programme
 Adopted by the Bowel Cancer Screening Programme
as measure of quality for potential screening units
 12 items divided into 2 domains, each with 4 levels
of achievement
 Mandatory on-line data returned twice a year from all
English Endoscopy Units
60
GRS Domains (2)
QUALITY AND SAFETY
 Appropriateness
(Guidelines & Audit)
 Consent process &
Patient information
CUSTOMER CARE
 Equality of access &
equity of provision
 Timeliness
 Choose and book
 Safety
 Privacy and dignity
 Comfort
 Aftercare
 Quality of procedure
 Ability to provide
 Communicating results
feedback to the service
to referrer
61
Global Rating Scale (3)
 Only those units scoring in top 2 levels of each
part of each domain to be Bowel Cancer
Screening Centres (BCSC)
 General improvement across the board in all
items measured over a 6 month period
 Being developed to include Training Rating
scale
62
Percentage change in GRS level A&B from
April
2005 to October 2005
Percentage change in GRS level A&B from April-05
to Oct-05
Ability to Provide Feedback to the
Service
Aftercare
% A&B in April
% A&B in Oct
Privacy and Dignity
Choose and Book
Timeliness
Items
Equality of Access and Equity of
Provision
Communicating Results to Referrer
Appropriateness
Quality of the Procedure
Comfort
Safety
Consent Process Including Patient
Information
0%
10%
20%
30%
40%
50%
60%
% rate of total results
63
Training and endoscopy
The Professions response
 BSG initiative led to establishment of the Intercollegiate Joint
Advisory Group on Gastrointestinal Endoscopy (JAG)
www.thejag.org.uk
 The JAG Holy Grail “ all endoscopists to be trained to the same
standards irrespective of their background”
As a consequence BSG/JAG has
 Developed core syllabus for endoscopy training
 Developed suite of Basic Skills Courses in each area of endoscopy
 Courses now accepted as mandatory for all trainee endoscopists
 3 National and 7 Regional Endoscopy Training Centres established
to deliver Basic and Advanced courses
 Programme funded by National Cancer Plan for England (£10.2M)
over last 5 years, but money runs out in mid 2006-2007 financial year
 Future uncertain, trainees may have to pay for courses
64
Workforce developments
 New training scheme, shift work, European Working
Time Directive;
results in reduction of training time by at least 25%
 Increased workload and targets
 Increased use of nurse endoscopists to provide
backbone of diagnostic endoscopy services
 DoH trial of non medical, non nursing endoscopists;
PA, Lab technician!
 Gastroenterologists with sub-specialization
(advanced endoscopy) being proposed by BSG
65
The BSG and Endoscopy.
What does it do?
 Largest section of Society, very active Committee
 Representatives on JAG and Statutory Committees
 Provides CPD and CME on Gastrointestinal Endoscopic
Subjects for BSG members and Associate members by
means of Symposia, Research paper and poster sessions
 Produces National Guidelines for the safe, effective practice
of endoscopy
−
−
−
−
−
−
Safe Sedation
Cleaning and Disinfection of Endoscopes
Informed Consent for Endoscopy
Antibiotic Prophylaxis
New Variant CJD
Non medical endoscopists
 Etc etc etc
66
Capsule endoscopes, the future has started!
67
British Society of Gastroenterology
Launch of Strategy Document
Dr Jeremy Sanderson
Chronic Diseases of the Gut
You are what you eat !…
69
The impact of chronic gut disease…
A
B
Major QOL impairment, occupational impact, even in mild disease
70
Normal gut function…
Gut “behaviour”
Genes
Bacteria
Diet
Lifestyle / Stress
Gut immune system
71
The spectrum of chronic gut disease
Normality
Irritable bowel syndrome
IBS
Inflammatory bowel disease
IBD
Diverticular disease
Coeliac disease
72
Irritable Bowel Syndrome (IBS)
 10 -22% of UK population
 Incidence rising
 Only half consult their GP
 40% avoidance activity – work, travel, leisure pursuit etc
 20-50% of Gastroenterology clinic workload
 Massive cost to society
 Causes of IBS poorly understood
73
Concept of functional gut disease
“Functional GI disorders”
 Chronic symptoms without structural abnormality
 Functional dyspepsia (indigestion)
 Non-cardiac chest pain
 Irritable bowel syndrome
“Motility disorders” (muscular dysfunction)
 Achalasia, gastroparesis
 Intestinal pseudo-obstruction
 Faecal incontinence
74
Inflammatory bowel disease (IBD)
Crohn’s disease &
Ulcerative colitis
 ¼ million cases in UK
 (1 in 1000 Crohn’s, 1 in 500
UC)
 Major morbidity and poor QOL
in young adults
 ~ £3000 per annum per patient
healthcare cost
Cause unknown:
interaction between genes and environment
75
Current issues in service
delivery for IBS and IBD
 High impact but low priority
 Cancer focus of targets
 Unmentionables
 Poorly understood – treatments modest
at best
76
Current issues in service
delivery for IBS and IBD
 Demand a multi-disciplinary approach
 Dieticians, nurse specialists, counselling
support etc
 Need evidence for optimal service delivery
 Major need for research funding
77
Provision of optimal service
for IBS and IBD
 Paradigms for Chronic disease management (CDM)
− move care closer to patient, self-care
− shared care agreements
− agreed patient pathways
 Multi-disciplinary team approach essential
 Key role for Nurse Specialists
78
Provision of optimal service
for IBS and IBD
 All patients should have access to dietetic services
 Access to other related services also important
− counselling, smoking cessation
 Improve specialist training at all levels
 Support for clinical and basic research
79
You are what you eat !…
…Depending on your
Gastroenterology
service?
80
British Society of Gastroenterology
Launch of Strategy Document
Professor Elwyn Elias
President of the BSG
Summary
Aims
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
82
Aim 1: To serve to care
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
Care needs to be seamless across boundaries
24/24 and 7/7 provision is essential
Continuity and teamwork are key elements
Standards must be acceptable
83
Aim 2: Improve Planning
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
BSG’s aims:
Planning of services to meet the requirements
for optimal patient care – continuity, expertise,
mutidisciplinary teamwork
84
Threats and challenges
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
PBC
PBR
ISDTC
85
Threats and challenges
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
?
?
CHOOSE!
PBC
?
?
PBR
IDC
86
Threats and challenges
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
CHOOSE!
& BOOK!
PBC
PBR
IDC
87
Caring for the I.B.D.patient
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
Nurse specialist
(stoma care)
Endoscopist
Gastroenterologist
Radiologist
(IBD specialist)
Histopathologist Gastrointestinal Surgeon
Nutritionist
88
Acute Gastrointestinal Haemorrhage
B.S.G. Position Statement
 In expert hands emergency interventional endoscopy for
patients with upper gastrointestinal haemorrhage had
the potential to save lives and by reducing morbidity to
prove cost effective
AIM
 BSG aims to ensure that all patients admitted to hospital
at any time of day or night are treated optimally by those
with the necessary expertise to save their lives when the
opportunity is presented
89
BSG representation to NICE
 To prepare a clinical guideline on the management, up
to the point of discharge from hospital, of acute upper
gastrointestinal bleeding in adults
 This should include:
− the respective roles of primary care and secondary care
in managing this condition, and;
− the competencies required by endoscopists performing
these operative procedures
90
Aim 1: To serve to care
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
Care needs to be seamless across boundaries
24/24 and 7/7 provision is essential
Continuity and teamwork are key elements
Standards must be acceptable
91
Aim 2: Improve Planning
The aim of this strategy is to provide a robust support for the
development and commissioning of Gastroenterology and Hepatology
services in the UK. We envisage it will be used in business planning
and service improvement in primary care at local Trust level and
regional level. We also expect it to be an essential document in
negotiations for improvement in service and future planning
BSG’s aims:
Planning of services to meet the requirements
for optimal patient care – continuity, expertise,
mutidisciplinary teamwork
92
British Society of Gastroenterology
Launch of Strategy Document
Questions
British Society of Gastroenterology
Contacts:
British Society of Gastroenterology
3 St Andrews Place
Regent's Park
London NW1 4LB
email
[email protected]
Web site
http://www.bsg.org.uk
94