Pan-London tuberculosis services: a service evaluation.

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• London exhibits the highest tuberculosis (TB) rates in Western Europe, with nearly half of new cases being drug-resistant.
• Significant variations in TB prevalence exist across London boroughs, indicating challenges in controlling TB transmission.
• Economic pressures compound difficulties in organizing and delivering effective TB services.

Purpose of the Study:

• To assess the structure and delivery of London's TB services, including leadership, management, coordination, and staffing.
• To identify tools for skill mix calculation to meet TB service delivery requirements across London.
• To inform a strategic framework for a pan-London TB service, potentially applicable to other European cities.

Main Methods:

• A multi-method service audit evaluation was conducted.
• Methods included documentary analysis, semi-structured interviews with TB service users (n=10) and professionals (n=13), and focus groups with TB nurses (n=8).
• Participants represented London's five sectors and non-London network professionals.

Main Results:

• TB services are predominantly hospital-based, with limited community-based options.
• Difficulties identified include delayed service access, low GP suspicion index, and restricted referrals.
• Shortages in the TB workforce, lack of managed accommodation, and insufficient social care/outreach support were highlighted.

Conclusions:

• Key issues in TB service organization, delivery, workforce, and skill mix require addressing for a strategic pan-London TB service framework.
• Enhanced strategic planning, coordination, and best practice sharing are essential.
• A review of the pan-London TB workforce development strategy, including professional roles, skills, and patient pathways, is needed.