Small Bowel Endoscopy in the UK
Dr Mark McAlindon - UK Capsule Endoscopy Users' Group - November 2011
A working party report on the provision of service and training for small bowel endoscopy in the UK by the UK Capsule Endoscopy Users' Group
In the UK, small bowel endoscopy service development has been driven locally rather than being planned, regulated and monitored. The working party aimed to establish the availability and uptake of services, clarify the current tarrifs and assess current provision of training in order to anticipate future demand, service needs and training requirements. This was done using surveys, personal contact and an estimation of need using current accepted indications and Hospital Episode Statistics data.
45% of UK gastroenterology services offered in-house capsule endoscopy. 91.3% of survey responders referred patients for capsule endoscopy; 67.7% felt that local availability would increase referrals. Suspected small bowel bleeding and Crohn's disease were considered appropriate indications by the majority. Demand is increasing in spite of restricted use in 21.6% of centres. Only two regions performed more than the minimum estimate of need of 45 procedures per 250 000 population. Eight centres perform regular device-assisted enteroscopy and 14 services are in development. 74% of trainees were interested in training and whilst most training in image interpretation are doctors (67%), 28% are nurses. The current basic tariff of £533 for capsule endoscopy (HRG code FZ42Z) and balloon-assisted enteroscopy of £630 (HRG code FZ24C) represent substantial shortfalls in the true cost of the procedures.
Thus, capsule endoscopy is used by the majority of UK gastroenterologists but appears to be underutilised. Current demand for device-assisted enteroscopy seems likely to be matched if new services become established. Future demand is likely to increase, however, suggesting the need to formalise training and accreditation for both doctors and nurses.