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New faecal calprotectin pathway brings patient benefits and NHS efficiencies

The Oxford AHSN is supporting the implementation and regional roll-out of a new faecal calprotectin (FCal) pathway.

The pathway helps GPs better diagnose between non-inflammatory diseases (such as irritable bowel syndrome) and inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis) by using revised diagnostic cut-offs – the presence of FCal in stool samples indicating inflammatory disease (a ‘rule in’ approach as opposed to the previous ‘rule out’ approach).

This test was developed by Dr James Turvill, Consultant Gastroenterologist at York Teaching Hospitals NHS Foundation Trust. The Yorkshire & Humber AHSN supported the development of the pathway and identified significant financial benefits, predicting savings of up to £2.5 million for the Yorkshire and Humber region alone.

Together, the Y&H AHSN and Dr Turvill standardised the new FCal pathway across CCGs in the Y&H region, liaising with eMBED Health Consortium to create SystemOne and EMIS templates and guiding GPs through the pathway. In parallel with this work, a consensus paper to support the use of FCal testing was commissioned by NHS England and endorsed by the Chief Scientific Officer.

The new FCal pathway  received national recognition, being shortlisted in the HSJ Awards (2017) and NICE Shared Learning Awards (2018). In 2018 the national AHSN Network selected FCal testing as a collaborative project and agreed to support clinical commissioning groups (CCGs) with spread and adoption.

The standardised York pathway encourages primary care clinicians to use FCal testing as a decision diagnostic, helping to reduce diagnostic uncertainty for patients and the potential for unnecessary and invasive testing. The uptake of the new care pathway impacts on the many patients who suffer from these distressing conditions, providing better and clearer answers for them much sooner, leading to improved patient outcomes and experience.

Alongside improved diagnostic and earlier treatment benefits to patients, CCGs have also identified substantial financial savings through a reduction in unnecessary diagnostic referrals to secondary care. The revised pathway reduces pressure on endoscopy services in secondary care and improves waiting times for patients requiring additional tests due to improved capacity, ensuring optimum use of limited NHS resources.

The Oxford AHSN has successfully supported the roll-out of the new pathway across seven GP practices in Buckinghamshire. We are engaging with further GP practices in Bucks and more in Berkshire and Oxfordshire. The Oxford AHSN will support CCGs in measuring local benefits.

Implementation tools including educational videos, business case templates and patient information leaflets are available from