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Colorectal
Original research
Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic
  1. Nicholas A Kennedy1,
  2. Richard Hansen2,
  3. Lisa Younge3,
  4. Joel Mawdsley4,
  5. R Mark Beattie5,
  6. Shahida Din6,
  7. Christopher A Lamb7,
  8. Philip J Smith8,
  9. Christian Selinger9,
  10. Jimmy Limdi10,
  11. Tariq H Iqbal11,
  12. Alan Lobo12,
  13. Rachel Cooney11,
  14. Oliver Brain13,
  15. Daniel R Gaya14,
  16. Charles Murray15,
  17. Richard Pollok16,17,
  18. Alexandra Kent18,
  19. Tim Raine19,
  20. Neeraj Bhala20,
  21. James O Lindsay21,
  22. Peter M Irving4,
  23. Charlie W Lees6,
  24. Shaji Sebastian22
  1. 1 Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
  2. 2 Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
  3. 3 Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, London, UK
  4. 4 Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
  5. 5 Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  6. 6 Department of Gastroenterology, Western General Hospital, Edinburgh, UK
  7. 7 Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  8. 8 Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  9. 9 Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  10. 10 Section of IBD, Division of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
  11. 11 Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  12. 12 Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  13. 13 Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  14. 14 Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
  15. 15 Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
  16. 16 Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
  17. 17 Department of Gastroenterology, St George's University of London, London, UK
  18. 18 Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
  19. 19 Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
  20. 20 Department of Gastroenterology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  21. 21 Department of Gastroenterology, Barts Health NHS Trust, London, UK
  22. 22 IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
  1. Correspondence to Professor Shaji Sebastian, IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; Shaji.Sebastian{at}hey.nhs.uk

Abstract

Objective To determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services.

Methods Internet-based survey by invitation of IBD services across the UK from 8 to 14 April 2020.

Results Respondents from 125 IBD services completed the survey. The number of whole-time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4–7.5 and median 3, IQR 2–4) to the point of survey (median 2, IQR 1–4.8 and median 2, IQR 1–3) in the 6-week period following the onset of the COVID-19 pandemic (p<0.001 for both comparisons). Almost all (94%; 112/119) services reported an increase in IBD helpline activity. Face-to-face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD-specific endoscopy and elective surgery.

Conclusions IBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high-quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post-pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.

  • inflammatory bowel disease
  • health service research
  • infectious disease

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/flgastro-2020-101520

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    Footnotes

    • Twitter @DrNickKennedy, @PaedsRH, @ShahidaDin1, @DrPhilipJSmith

    • CWL and SS contributed equally.

    • Correction notice This article has been corrected since it published Online First. The author's name R Mark Beattie has been corrected and ORCID ID has been added and the acknowledgement statement has been updated.

    • Collaborators On behalf of the UK IBD COVID-19 working group (see appendix for details).

    • Contributors The original project was conceived by SS and the survey developed by SS, CWL, NAK, RH and LY. Analyses were performed by RH and NAK. The initial draft of the manuscript was written by SS, RH, LY and NAK. All of the remaining authors contributed to data collection and to further writing of the manuscript. The other listed contributors performed data collection. All authors and contributors were given the opportunity to review the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Deidentified participant data are available by request from the corresponding author.

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