GPs to screen new patients for TB

Patients registering with GP practices will have to be assessed for TB risk and those in certain high-risk groups sent for a chest X-ray, under the NICE clinical guideline on the identification, prevention and treatment of TB.

NICE wants all immigrants to England and Wales, as well as citizens returning from countries with a high incidence, to have a chest X-ray unless pregnant or under 11.

Screening patients registering with GPs would be a way of identifying these new entrants, it says.

East London GP Dr John Hayward, a public health adviser and co-chairman of the NICE Guideline Development Group said: 'GPs need to be new-entrant aware, but screening them isn't part of the GMS contract.

'Unless this is part of a local service, GPs won't be involved. It's up to PCTs and SHAs to put a system in place.'

The NICE guideline highlights the main risk factors for TB as: being HIV positive; having resided abroad in an area with a high TB incidence; or living in a UK community that has a high incidence of TB.

'TB is out there more than it has been in recent years and it is something people tend to forget,' said Dr Hayward.

'TB should be considered in patients generally unwell with weight loss, night sweats and cough. Blood doesn't always appear in the sputum in the early stages, and patients with these symptoms should be referred immediately.'

The guideline also outlines a tougher standard drug regimen, where patients receive six months' treatment with isoniazid and rifampicin, with pyrazinamide and ethambutol for the first two months.

All patients should be assessed for compliance.

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