In April, 2013 NHS England changed the way the management and treatment of Interstitial Lung Diseases (ILD) were to be organised.
Previously, treatment for ILD was provided by individual Hospital Trusts responding to local Primary Care Trust requirements. Each of these Trusts operated independently, which led to variation from region to region in the access to various services for ILD throughout the UK. Now, these services are commissioned (paid for)nationally, which should mean consistent access to treatment for all patients.
This new policy will lead to the creation of Specialist ILD Centres, but as yet no formally designated centres have been identified. Guidelines have been laid down by NICE – The National Institute for Health & Care Excellence – regarding numbers, staffing, qualifications and experience. NICE defines a specialist ILD Physician as someone who runs a service seeing at least 500 ILD patients per year or who has done an MD/PHD in ILD or a clinical fellowship in ILD for at least 6 months.
The NICE guideline also suggested that for an ILD network of 1.5 million people there should be 1 Specialist IPF Physician and 6 local Multi-Disciplinary Teams. However, if those guidelines were followed, which seems unlikely in the current commissioning environment, it would lead to 35 ILD Centres in England. The actual number is likely to be fewer.
In fact, NHS England is now made up of 12 areas called ‘Senates’ and it is likely that each area will have one Specialist ILD Centre although some may have two. London is the exception and the capital will probably have three or four. However, the precise number and location will be determined by the Senate local area teams, dependent upon the number of patients with ILD seen in that particular Senate area.
There are a number of NHS Trusts that have been granted approval by NHS England to prescribe Pirfenidone from July 2013, however, this is a dynamic process and it may be updated over the coming months. Those hospitals currently prescribing Pirfenidone may eventually become Specialist ILD Centres but that is by no means certain. Not all hospitals can prescribe Pirfenidone – please refer to the table below to find out which hospitals can prescirbe Pirfenidone.
Hospitals currently permitted to prescribe Pirfenidone (as of May 2013)
The situation is different in Scotland and Wales but it is likely that Glasgow, Edinburgh and Cardiff will be regarded as ILD Centres on the basis of current NICE Criteria.