Please note this scheme is only for re-tests. Stool samples should be used for initial diagnosis tests.

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1 Specification for Local Improvement Scheme Carbon 13 Helicobacter Urea Breath Testing Introduction The local improvement scheme has been designed by NHS Liverpool Clinical Commissioning Group to facilitate improving the quality of services provided by list based General Practice providers. This improvement scheme will facilitate improved access to diagnostic testing for helicobacter testing and thus reducing gastroenterology referrals to secondary care by improving access to testing in Primary Care. Aims Please note this scheme is only for re-tests. Stool samples should be used for initial diagnosis tests. To provide the Helicobacter Carbon 13 urea breath test (UBT) to patients aged 16 and over presenting with dyspeptic symptoms as indicated along the North Mersey Dyspepsia pathway where alarm signals have been excluded by the referring clinician and gastro-oesphageal reflux disease where helicobacter infection is suspected or is to be eliminated. Appendix 1 provides the referral and clinic process for providers Appendix 2 provides the information for patients to prepare for the test Appendix 3 provides the minimum dataset for the service Providers can opt to: a) Provide the service for their own patients b) Provide the service for their own patients and patients from other practices This Local Improvement Scheme is valid until 31 st March Service Specification Patient Pathway Patient s GP decides with patient to have a Helicobacter urea breath test in accordance with the North Mersey Dyspepsia pathway Patient is given an information leaflet (if own practice provides service) or a booking letter (if own practice does not provide service). It is important that the patient reads the leaflet before attending for the test and brings it with them. 1

2 The patient contacts Primary Care provider (either own GP or another practice) and asks for an appointment (minimum 20 minutes required) for a Helicobacter urea breath test The receptionist makes appointment using either the practice clinical system (if own patients) or EMIS web (if patient from another practice) taking into consideration the instructions detailed within the patient information leaflet. The patient attends appointment with information leaflet or booking letter. The patient is asked to provide a breath sample by breathing through a straw into 2 small tubes. The patient is then given a small quantity of carbon 13 urea dissolved in water. After a period of 10 minutes, the patient is asked to provide a second breath sample. The test is then sent through the post to the lab (analysis is included within the purchase price of the test kit and currently processed through Analytical Services Int.Ltd St George s University of London). Results are returned to the patient s own practice within 2 weeks and any subsequent follow up actioned appropriately. Providers will be expected to: Offer a timely response (within 5 weeks) to requests for appointments at the surgery for the investigation (some drugs may have to be stopped for up to 4 weeks before the test) Manage receipt of the referral and process for booking appointments Provide advice and prepare the patient prior to the investigation. Use the preferred test which is Diabact Urea Breath Test (UBT) Treat all patients as individuals being sensitive to the cultural/physical and emotional needs of the patient. Inform the referring clinician where appropriate that the test was: o Completed and when to expect the results o Not completed as medication not stopped or patient not fasted o Not completed as the patient did not attend o Not completed as the patient cancelled the appointment. Ensure appointments are available at suitable times, preferably in the morning as the patient is required to fast for a period of 6 hours before the test is carried out. 2

3 Provide all resources required to deliver the service including test kits, stationery (including postage costs), staffing costs, insurance and any other associated costs. Kits can be obtained from Analytical Services International Ltd, St. George s, University of London, Cranmer Terrace, London, SW17 0RE. Premises This test should be carried out in a GP consulting room/clinical room with adequate provision for patients to wait whilst the test is carried out. Staffing The Provider will ensure that staff are suitably trained, qualified and competent to deliver the service and ensure supervision arrangements are in place for all practitioners. The Provider will have a programme of professional training / development relevant to the service delivery. There will be appropriate induction for new staff and on-going mandatory training arrangements A lead Doctor must be identified within each practice To deliver the components in The Helicobacter Urea Breath Testing Local Improvement Scheme, practitioners must: o Be appropriately trained to provide this service safely following clear instruction from the doctor for administration (the delivery of an inert substance being central to the test). o Providers will be required to certify that such training has been undertaken. o o An overview with instructional video can be found here: o A comprehensive online accreditation course can be free and can be accessed from: (registration required) 3

4 Monitoring Read Codes Urea Breath Test Undertaken CODE 4JM% DESCRIPTION Helicobacter breath test Data Collection/submission: Practice to deliver service for their own patients: Practices will be expected to utilise their own clinical system to record patient attendances from their own practice. Funding Practice to deliver service for their own patients: Patient seen in service and test completed xxx Patients attends but test not performed as 0 patient not fasted Patient attends but test not performed as 0 patient not stopped medication as directed Appointment made but patient cancelled 0 Appointment made but patient did not 0 attend (DNA) No payment will be made for patients that do not attend their appointment. In such cases, patients should be offered one further opportunity to attend. Where the service is being provided on behalf of other practices and the patient does not attend the referral should then be returned to the patient s GP. Termination The contractor will give three months notice in writing if they wish to terminate this agreement. The CCG reserves the right to terminate this agreement immediately should a breach of contract/clinical governance become apparent. 4

5 Sign Up Please sign and return the appropriate declaration. I confirm that this Practice wishes to provide the H Pylori Local Improvement Scheme (own patients) from 1 st April 2018 to 31 st March 2019 as per the above specification for its own registered population only. Name of Practice:.. Date completed:. /. /. Signed: 5