Colorectal

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Original research

Organisational changes and

challenges for inflammatory bowel
disease services in the UK during the
COVID-19 pandemic
Nicholas A Kennedy ‍ ‍,1 Richard Hansen ‍ ‍,2 Lisa Younge,3
Joel Mawdsley,4 R Mark Beattie ‍ ‍,5 Shahida Din,6
Christopher A Lamb ‍ ‍,7 Philip J Smith ‍ ‍,8 Christian Selinger,9
Jimmy Limdi,10 Tariq H Iqbal,11 Alan Lobo,12 Rachel Cooney,11
Oliver Brain,13 Daniel R Gaya,14 Charles Murray,15 Richard Pollok,16,17
Alexandra Kent,18 Tim Raine,19 Neeraj Bhala,20 James O Lindsay,21
Peter M Irving ‍ ‍,4 Charlie W Lees,6 Shaji Sebastian ‍ ‍22

►► Additional material is Abstract

published online only. To view Summary box
Objective To determine the challenges in
please visit the journal online
(http://​dx.​doi.o​ rg/​10.​1136/​ diagnosis, monitoring, support provision in the
flgastro-​2020-​101520). What is already known on this topic
management of inflammatory bowel disease
►► COVID-19 pandemic is expected to pose
(IBD) patients and explore the adaptations of IBD
For numbered affiliations see end a myriad of challenges to National Health
of article. services. Services.
Methods Internet-­based survey by invitation of ►► Essential services for inflammatory bowel
Correspondence to IBD services across the UK from 8 to 14 April disease (IBD) patients including outpatient
Professor Shaji Sebastian, IBD
Unit, Hull University Teaching 2020. care, advice lines, endoscopy and infusion
Hospitals NHS Trust, Hull HU3 Results Respondents from 125 IBD services units may be affected.
2JZ, UK; S​ haji.​Sebastian@h​ ey.​ completed the survey. The number of whole-­time
nhs.​uk What this study adds
equivalent gastroenterologists and IBD nurses ►► This survey evaluates the challenges to
CWL and SS contributed equally. providing elective outpatient care decreased IBD services during the pandemic and the
significantly between baseline (median 4, IQR adaptations to meet these challenges.
Received 30 April 2020
Revised 29 May 2020 4–7.5 and median 3, IQR 2–4) to the point of ►► There is significant reduction in staffing
Accepted 30 May 2020 survey (median 2, IQR 1–4.8 and median 2, IQR resources for the IBD team and significant
Published Online First 1–3) in the 6-­week period following the onset increase in IBD advice line contact.
16 June 2020 ►► Face-­to-­face consultations in outpatients,
of the COVID-19 pandemic (p<0.001 for both
comparisons). Almost all (94%; 112/119) services non-­emergency endoscopies and elective
IBD have been significantly curtailed.
reported an increase in IBD helpline activity.
►► There is increased uptake of telemedicine,
Face-­to-­face clinics were substituted for telephone
virtual multidisciplinary team meetings
consultation by 86% and video consultation by and non-­invasive monitoring of patients.
11% of services. A variation in the provision of
laboratory faecal calprotectin testing was noted increased workload and to maintain IBD services is
with 27% of services reporting no access to faecal essential to ensure patient safety.
calprotectin, and a further 32% reduced access.
There was also significant curtailment of IBD-­ Introduction
specific endoscopy and elective surgery. The COVID-19 pandemic has significant
Conclusions IBD services in the UK have implications for the diagnosis and manage-
© Author(s) (or their employer(s)) implemented several adaptive strategies in order to ment of patients with gastrointestinal
2020. No commercial re-­use. See
rights and permissions. Published continue to provide safe and high-­quality care for conditions including inflammatory bowel
by BMJ. patients. National Health Service organisations will disease (IBD).1 Healthcare systems have
To cite: Kennedy NA,
need to consider the impact of these changes in had to adapt rapidly to maintain provision
Hansen R, Younge L, et al. current service delivery models and staffing levels of core services and reduce unintended
Frontline Gastroenterology when planning exit strategies for post-­pandemic consequences from the necessary diver-
2020;11:343–350.
IBD care. Careful planning to manage the sion of resources to focus on the pandemic.

Kennedy NA, et al. Frontline Gastroenterology 2020;11:343–350. doi:10.1136/flgastro-2020-101520 343

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of a UK consensus on management of IBD during the
Summary box
COVID-19 pandemic.8
The impact of the COVID-19 pandemic on provision
How might it impact on clinical practice in the
of IBD care has not been previously evaluated. Most
foreseeable future
centres have rapidly and independently reconfigured
►► There is urgent need to review models of care and
staffing levels of IBD service in planning exit strategies in their services guided by local management decisions
the post -pandemic period. based on varying service needs, redeployment of some
►► Insights gained from the rapid adaptations by of their staff and reconfiguration of available health-
services during the peak of the pandemic may present care facilities. There has been limited opportunity or
opportunities for positive changes in IBD services. time to share experience of service reconfiguration
to determine the impact across regions. We surveyed
adult and paediatric gastroenterology services caring
The continued accumulation of cases positive for for IBD patients in the UK to assess the impact of
SARS-­CoV-2 and the intervention from national govern- COVID-19 on service delivery.
ments to enforce strict social isolation (‘shielding’) and
distancing have necessitated IBD services to dramati- Methods
cally changing and restructuring the way they provide We developed an internet-­based survey using Google
care for IBD patients.2 In addition, the rapid increase Forms (Google, California, USA) to assess changes to
in COVID-19 hospitalisations along with restrictions IBD service provision in the COVID-19 period. This
in endoscopic and surgical facilities has resulted in the was circulated to IBD services throughout the UK
redeployment of clinicians and nurses to front-­ line through the membership of the UK IBD COVID-19
services to care for these patients with resultant impact working group and social media. The Royal College
on the delivery of IBD care.3 In IBD, delays in diagnosis of Nursing (RCN) IBD specialist nurse network and
and therapy can have serious consequences including the the service leads of the services participating in the
need for emergency surgery.4 IBDUK self-­assessment were also invited to participate.
Patients are understandably concerned about the Furthermore, the survey was emailed to the member-
impact of their IBD and its treatment on their risk of ship of the British Society of Paediatric Gastroenter-
severe COVID-19 disease. However, it is important ology, Hepatology and Nutrition (BSPGHAN). Survey
that IBD patients continue to attend for inpatient, day participation was voluntary, and the option was given
case and outpatient hospital care for the management to provide the National Health Service (NHS) Trust
of active disease and complications and for thera- identity and contact details with the option of being
pies such as intravenous biologics. Furthermore, given contacted for future surveys related to this subject. The
that immunosuppressive and biologic agents form the survey was carried out between 8 and 14 April 2020,
cornerstone of IBD management, concerns have been which corresponded to 1 month after the UK govern-
raised that patients with IBD may be more susceptible ment decision for lockdown. The survey (included in
to SARS-­CoV-2 infection and whether they may have online supplementary appendix) covered the char-
poorer outcomes if infected with the virus.5 6 Although acteristics and staffing resources of the services, the
there are, as yet, no specific data quantifying additional changes instituted in provision of IBD care in prepa-
risk, specialist societies and expert groups have recom- ration for the COVID-19 pandemic and the impact of
mended heightened vigilance.7–9 In the UK, patients the pandemic on the provision of IBD services. Data
categorised as high risk have been recommended for were collected in Google Docs and then exported for
isolation (‘shielding’) by UK Department of Health analysis to Microsoft Excel (Microsoft, Washington,
and Social Care,10 requiring individual IBD services to USA) and R V.3.6.0 (R Foundation for Statistical
rapidly identify individuals in this group using hospital Computing, Vienna, Austria). Where more than one
databases and registries. response was received from the same IBD service,
The UK has a strong record of providing personalised the most recent response was used, though paediatric
multidisciplinary care for patients with IBD. Succes- and adult services were counted as separate. Response
sive IBD audits have shown improvements in resource frequencies were tabulated and expressed as percent-
provision (including IBD nurses) and overall quality of ages of total responses; where there were incomplete
care.11 12 More recently, a multidisciplinary stakeholder responses to a question, this is reflected in the relevant
group has proposed key quality standards for IBD care denominator. Wilcoxon signed-­rank tests were used to
in the UK.13 Maintaining high-­quality care during the compare paired continuous variables. Fisher’s exact
COVID-19 pandemic will remain a constantly evolving test was used to compare categorical data.
challenge. IBD clinicians and specialist nurses across the
UK have formed an IBD COVID-19 working group to Results
share expertise and promote a collaborative and co-­ordi- Respondents
nated nationwide approach to meet the challenges posed We received 147 responses representing 125 IBD
by the pandemic. This has enabled the development services (England 106, Scotland 9, Wales 8 and

344 Kennedy NA, et al. Frontline Gastroenterology 2020;11:343–350. doi:10.1136/flgastro-2020-101520

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redeployment (51% (64/125) and 40% (50/125),
respectively), self-­isolation due to COVID-19 symp-
toms (22% (27/125) and 17% (21/125)) and belonging
to the shielding category (9% (11/125) and 14%
(18/125)). The number of WTE nurses in adult IBD
services dropped significantly from median 3 (IQR
2–4) to 2 (IQR 1–3, p-­ value<0.001). In paediatric
services, the median number of nurses was 2 (IQR 1–2)
prior to COVID-19 and 1 (IQR 1–2) in the COVID-19
era (p=0.24).
The median number of WTE gastroenterologists
and IBD nurses required to provide IBD care for
adult patients as self-­assessed by our respondents were
4.0 (IQR 2.4–5.0) and 3.0 (2.0–4.0), respectively.
For paediatric services, the median number of WTE
gastroenterologists and IBD nurses required to provide
IBD care was reported as 2.0 (IQR 1.0–3.0) and 1.0
(1.0–2.0), respectively. When asked about the possi-
bility of reduction in staff numbers below this required
Figure 1 Likelihood of having less than the minimum number of number as a result of COVID-19, 60% (72/119) of
required IBD healthcare professionals during the COVID-19 era. IBD, services thought this was certain or highly likely for
inflammatory bowel disease. gastroenterologists and 63% (70/123) for IBD nurses
(figure 1).
Only 7% (9/125) of services reported that their
Northern Ireland 2) representing approximately 70% IBD nurses could maintain their normal service. IBD
of the IBD services in the UK (paediatric services 19% specialist nursing support for inpatients was either
of the total). Respondents included 65 (44%) adult not available for 26% (32/125) or curtailed by 31%
gastroenterologists, 53 (36%) adult IBD nurses, 21 (39/125) of the services. Similarly, nurse-­ led outpa-
(14%) paediatric gastroenterologists, 6 (4%) paedi- tient clinics had been suspended by 27% (34/125) and
atric IBD nurses and 1 IBD surgeon. Only the most reduced in a further 26% (33/125) of services.
recent response for each service was used. Fifty-­seven
per cent (71/124) were dedicated IBD services and Impact on IBD service functions
43% (53/124) were general gastroenterology services Clinics
providing IBD care. Fifty-­ seven per cent (70/123) Significant changes were reported in the provision of
of the services were based in a university teaching outpatient IBD clinics. No service reported continuing
hospital, while 42% (52/123) were based in district normal activity with routine face-­to-­face appointments.
general hospitals. All services who responded were Nine per cent of services reported running face-­to-­
based in public hospitals in the UK NHS. face clinics with reduced capacity, and 30% (38/125)
reported complete cancellation of routine clinics.
Impact on work force Face-­to-­
face clinics were substituted with telephone
The overall number of whole-­time equivalent (WTE) consultation by 86% (108/125) and video consultation
gastroenterologists and IBD nurses providing elective by 11% (14/125) of services; most services (13/14)
outpatient care decreased significantly between base- using video were also using telephone consultations.
line (median 4, IQR 4–7.5 and median 3, IQR 2–4) The proportion of patients reviewed using telephone
to the point of survey (median 2, IQR 1–4.8 and clinics was 100% in half of services (61/124) and above
median 2, IQR 1–2) 6 weeks following the onset of 50% in a further 32% (40/124). In contrast, only 19%
the COVID-19 pandemic (p<0.001 for both compar- of services (23/123) reported having access to video
isons). The proportion of services with more than consultation, with the majority (20/25) having access
three WTE gastroenterologists providing IBD care was to video facilities reporting that they used them for less
81% (100/124) at baseline but fell to 34% (41/122) than a fifth of their consultations. We observed the use
as a result of reconfiguration (p<0.001), with 8% of patient apps in some services with 6% (7/123) and
(10/122) services having no dedicated IBD clinician in 14% (17/123) of respondents, respectively, reporting
the COVID-19 era. Similarly, the number of services current use or in set up.
with more than one WTE IBD nurse fell from 81%
(100/124) to 53% (63/118) (p<0.001). Eight per cent Infusion services
(9/118) of services stated that they had no provision Drug infusion services were relocated to a ‘safer
for IBD nurse care. The main reasons given for the area’ away from acute services by 50% (62/125).
reduction in gastroenterologists and IBD nurses were The majority, 62% (77/125), reported performing a

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Endoscopy
In keeping with national guidance,14 endoscopy
activity has been significantly curtailed for IBD patients
with current provision only being available for defined
high priority indications (figure 3). In 35% (44/125)
of services, all IBD-­related endoscopy activities have
been cancelled.

Provision of IBD surgery

Potential elective surgery for IBD has been put on
hold/withheld in all services surveyed. Indications for
surgery that may be permitted include emergency small
bowel resections in 74% of services (93/125), colec-
tomy for acute severe colitis in 72% (90/125), peri-
Figure 2 Change in inflammatory bowel disease advice line calls anal surgery in 42% (52/125) and colectomy for IBD
during the COVID-19 era. dysplasia in 4% (5/125). In 10% (13/125) of services,
all IBD surgery has been stopped.
prescreening check list for COVID-19 before patients
were invited to attend infusion services for treatment. IBD multidisciplinary team meetings (MDTs)
Most services (77%, 96/125) reported maintaining All IBD MDTs have been cancelled in 28% (34/122)
infusion intervals with ‘enhanced provisions’ to reduce of the services, while 40% (49/122) have converted
transmission but 11% (14/125) reported delaying them to virtual MDTs. Twenty-­five per cent (30/122)
treatment. Masks were reported as being used by staff of services are still running face-­
to-­
face MDTs, but
in 61% (76/125) of services and by patients in 24% with reduced capacity and/or social distancing. A
(30/125). Seven per cent (9/125) of services reported small proportion either have put in place alternative
proactively switching their patients from intravenous arrangements (2%; 3/122) or never had MDTs to start
to subcutaneous biologics. Sixty-­two per cent (78/125) with (5%; 6/122).
of services reported patient-­initiated cancellation of
at least some infusions; the most frequently reported Laboratory services
proportion was approximately 10% of patients. Less frequent blood monitoring regimens for patients
Patient-­reported reasons for cancellation included self-­ on immunomodulators have been adopted by 65%
isolation due to COVID-19 symptoms and fears and (79/121) of services, while 6% (7/121) have stopped
concerns about therapies. Iron infusion services have all routine blood monitoring. The remainder of
been completely stopped by 16% (20/125) or curtailed
by 45% (56/125) of services, respectively.

IBD advice line

The majority of services (94%; 112/119) report an
increase in IBD advice line activity, with 80% (95/119)
reporting a more than 50% increase and 34% (41/119)
reporting a more than doubling of activity (figure 2).
Services are adapting to this increased demand using
strategies such as an automated email (41%; 51/125),
voice message response (45%; 56/125), more contact
options (12%; 15/125) and additional staff overseeing/
providing IBD advice line services (10%; 13/125).
Conversely, 29% (36/125) have reported a reduction
in the number of staff providing advice line services.

Homecare services
Twenty-­seven per cent (33/121) of services reported an
inability to set up new homecare services for subcu-
taneous biologics and immune-­modulatory therapy. In
addition, 20% (25/122) also experienced disruption
to the homecare delivery provision of therapies due
to provider issues (28%; 3/125), blood monitoring
issues (5%; 6/125), pharmacy issues (4%; 5/125) and a Figure 3 Endoscopy provision during the COVID-19 pandemic. IBD,
reduced number of nurses (5%; 6/125). inflammatory bowel disease.

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services (29%; 35/12) reported that they were contin-
uing normal monitoring arrangements.
There was significant variation in the provision of
laboratory faecal calprotectin testing. A quarter of
services (33/122) have no access to faecal calprotectin,
while a further 32% (39/122) have reduced access.
Point-­
of-­care calprotectin has been introduced in
5% (6/120) of services and scaled up in 2% (3/120);
however, most services do not have access to point-­of-­
care calprotectin analysis.

Flare services
Only half of the services (50%; 63/125) are providing
access to face-­to-­
face flare clinics. However, 77%
(96/125) have access to blood tests in secondary care
and 62% (77/125) to blood tests in primary care,
while 12% (15/125) of services report no access at all
to blood tests for flare. Fifty-­eight per cent (73/125)
had access to faecal calprotectin testing (home or labo-
ratory for flare managements). Endoscopy was only
being used to assess suspected flares in outpatients
with known IBD in 6% (8/125) of services.

Identification of high-risk patients

The UK Government introduced guidance on 21/22
March 2020 to protect patients at risk of contracting
COVID-19 based on emerging world data/medical
advice. The concept of shielding was introduced,
requesting patients in the highest risk category to with-
draw from society in their own homes for a period
of 12 weeks. To support this endeavour, specialist
societies including the British Society of Gastroenter-
ology developed guidance to risk stratify patients.8
NHS trusts and health boards then had to iden-
tify the highest risk patients based on these criteria.
At the time of the survey, 61% (76/125) of services
reported having undertaken identification of high-­risk
patients who meet the criteria for shielding in their
IBD cohorts and 76% (95/125) have already commu-
nicated with their highest risk patients. Furthermore,
34% (42/125) of the services have communicated with
their moderate risk patients. Seventy eight per cent of
services (96/123) reported an intention to participate
in the SECURE-­ IBD registry (https://​ covidibd.​
org),
which is recording the number of COVID cases in IBD
patients; this includes 11% (14/123) who had already
entered patients.

Geographic variation
Exploration of the variation in provision of services
around the UK, including faecal calprotectin, endos-
copy and surgery, did not reveal any particular clus-
tering of loss of service into one region of the country
(figure 4).

Figure 4 Geographic variation around the UK in changes to Discussion

provision of (A) faecal calprotectin, (B) endoscopy and (C) surgery. IBD, The COVID-19 pandemic is having a pronounced
inflammatory bowel disease. impact on the lives of patients and healthcare

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professionals (HCPs). IBD services in the UK mean- of teleconsultation tools are urgently warranted. There
while have also needed to adapt their priorities rapidly is an ongoing international survey of telemedicine in
and modify current models of service to ensure delivery IBD in the COVID-19 era organised by the Interna-
of a minimum standard of safe and effective care. This tional Organisation for the Study of IBD.
involved an urgent redesign of clinical services with IBD patients appear to be receptive to the idea of
clear communication among HCPs to develop an non-­ face-­
to-­
face review where appropriate, with
iterative model of care, responsive to the challenges low levels of non-­attendance reported to telephone
posed by the unpredictable pandemic. The aim of this and virtual appointments.19 Reviewing patients also
survey from the UK IBD COVID-19 working group provides an opportunity to check their understanding
was to explore, consider and disseminate examples of of the ongoing pandemic, the impact it has on them as
dynamic models of service provision. individuals and any effect it may have on their treat-
Dramatic and significant reductions in staffing ment. This should promote adherence to therapy, as
levels have inevitably impacted negatively on service well as facilitating early management of disease flares.
provision and delivery. This has affected routine care Future surveys should assess patients’ preferences
for people with IBD including disease and treatment for telemedicine as we plan services following the
monitoring, clinical and endoscopic assessment, endo- COVID-19 pandemic.
scopic surveillance, access to elective and semiurgent IBD endoscopy practice during the ongoing
surgery and multidisciplinary team working. Despite COVID-19 pandemic appears to be broadly in line with
this, most services have been able to adapt and have national and international consensus.14 20–22 Endos-
been innovative with service delivery and models of copy services have been rationalised to provide the
care with the aim of providing safe and effective care. most urgent information for the safe care of patients
The unprecedented scale of this pandemic and such as in the management of acute severe colitis. Simi-
uncertainties driven by the absence of ‘effective’ treat- larly, elective surgery has been stopped with a focus
ment for COVID-9 has important implications for on emergency surgery for acute severe colitis, emer-
contingency planning with existing, evolving and aspi- gency small bowel resection and drainage for perianal
rational models of care delivery. Important elements sepsis. There are concerns about the potential impact
such as staffing levels from redeployment, provision of delaying elective endoscopies and operations in
of ‘adequate’ monitoring, clear routes of access to patients with IBD. Services will need to make plans
specialist advice and urgent review, and the ability to for appropriate prioritisation of delayed procedures
start, continue and monitor effective therapies and including those needing diagnosis of new IBD or/and
outcomes will need careful consideration. those needing surveillance to ensure safety in the post-­
The high level of contact with IBD services by pandemic era.22
patients since the start of the pandemic demonstrates Currently, the UK consensus guidelines do not
the ongoing requirement for suitably staffed advice recommend cessation of therapies such as biologics
lines and access to expert review, whether by tele- and immunomodulators in IBD patients who currently
phone, video or face-­to-­face clinics. do not have COVID-19.8 In those who stop therapies
Wherever possible, arrangements should be made during illness with SARS-­CoV2 or following a posi-
to facilitate some method of ongoing regular, sched- tive test, current guidelines recommend that biologics
uled MDT working, for discussion of complex or and immunomodulators are recommenced soon after
concerning cases needing consensus opinion. In cessation of symptoms.8 9 The IBD services surveyed
addition, there will arguably be benefit to all team here appear to have taken prompt action to ensure
members of accessing peer and colleague support. continuity of treatments in infusion units, but logistical
Videoconferencing platforms provide a means to facil- challenges with location and delivery of treatments
itate such discussions while ensuring staff can practise remain; a significant proportion of services reported
social distancing and, where possible and appropriate, difficulties in delivery of infusions. This may worsen
work remotely. Where scheduled MDTs, either virtual as the pandemic progresses over time due to patient
or face to face, are no longer feasible due to changes in factors such as shielding, isolation due to contact and
work schedules, other models of delivering care could fears about safety as well as staffing-­related challenges
be considered. Informal arrangements such as discus- depending on the duration of the pandemic or indeed
sion by email involving a suitable mix of specialist can new peaks in the pandemic. Adoption of subcutaneous
provide short-­term alternatives. therapies among patients starting biologic therapy
There has been rapid uptake by services of tele- may reduce the pressures on infusion units and
phone clinics, and some centres have instituted video reduce patient footfall in the hospital site. However, a
consultations. Previous studies15–17 have assessed the concerning number are reporting difficulties in starting
impact of telemedicine systems in IBD assessing feasi- new home care treatments and also in the delivery of
bility, patient acceptance, effectiveness and impact ongoing treatments, which needs addressing urgently.
on healthcare utilisation. However, there are several IBD advice lines are an immensely valuable resource
potential barriers18 and further adoption and upscaling for patients with IBD,23 and this is more so when

348 Kennedy NA, et al. Frontline Gastroenterology 2020;11:343–350. doi:10.1136/flgastro-2020-101520

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elective activity has been curtailed as evidenced in our Conclusions
survey. The marked increase in the number of patients In this survey, we provide a comparative reference
accessing IBD advice lines, coupled with a reduction in to support consistency of care across the UK during
the number of staff in more than a quarter of services, a difficult time and to offer a template to centres in
is likely to impact provision of prompt support and other countries, which have yet to undergo such alter-
advice to patients, who are understandably concerned ations. It is our hope that this will allow services to
about the potential impact of IBD and their medica- make suitable arrangements to maintain high-­quality
tions during the COVID-19 pandemic. Services have uninterrupted care for patients with IBD. The ongoing
attempted to provide more online support, but the COVID-19 pandemic has and may continue to pose
unprecedented increase in number of contacts may myriad challenges to healthcare systems across the
prove overwhelming. It is likely that requests for globe. IBD services in the UK and other countries will
advice regarding social distancing and shielding will face unique challenges both during the peak and post-­
reduce, but the number of patients contacting IBD peak pandemic period with respect to responsive and
advice lines for flare management may rise as routine responsible adaptation of service delivery. These are
outpatient clinics have been stopped or have limited unprecedented and challenging times. Yet, even grim
access in many centres. challenges present opportunities not in the least with
Non-­ invasive assessment and monitoring of IBD insights gleaned from rapid adaptation of models of
are critical during the COVID-19 pandemic. Hence, service delivery some of which are likely to be also
it is unfortunate that several services report cessation suitable in a post-­COVID-19 world. Indeed, there may
of faecal calprotectin services, mainly due to concerns be opportunities for positive changes in IBD services
regarding risks to laboratory staff, although faeco-­ resulting from this difficult time.
oral transmission is not confirmed yet. SARS-­CoV-224
Author affiliations
has been detected in faeces even in asymptomatic 1
Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
2
patients with COVID-19; however, it is not clear if 3
Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
Department of Gastroenterology, St Mark’s Hospital and Academic Institute,
this represents live virus. One option for such services Harrow, UK
is to initiate and upscale the use of point-­of-­care faecal 4
Department of Gastroenterology, Guy’s and Saint Thomas’ NHS Foundation
calprotectin testing.25 A major concern highlighted by Trust, London, UK
5
Department of Gastroenterology, University Hospital Southampton NHS
this survey is the significant reduction in both clini- Foundation Trust, Southampton, UK
cians and specialist nurses available to care for IBD 6
Department of Gastroenterology, Western General Hospital, Edinburgh, UK
7
patients. More than 50% of the respondents felt that Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS
Foundation Trust, Newcastle upon Tyne, UK
the services would remain understaffed and unable 8
Department of Gastroenterology, Royal Liverpool and Broadgreen University
to meet the needs of IBD patients. Redeployment to Hospitals NHS Trust, Liverpool, UK
9
front-­line COVID-19 duties appears to be the main Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
10
Section of IBD, Division of Gastroenterology, Pennine Acute Hospitals NHS
factor, and this may need addressing at unit level with Trust, Manchester, UK
measures such as creation of a designated core team 11
Gastroenterology, University Hospitals Birmingham NHS Foundation Trust,
of clinicians and specialist nurses to deliver IBD care, Birmingham, UK
12
Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS
as adopted by centres in Italy.26 We should also ensure Foundation Trust, Sheffield, UK
that, where the local COVID-19 situation permits, 13
Translational Gastroenterology Unit, Oxford University Hospitals NHS
IBD specialist nurses and doctors are able to resume Foundation Trust, Oxford, UK
14
Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
their responsibilities in IBD care. 15
Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
Our survey has some limitations. We could not 16
Gastroenterology, St George’s University Hospitals NHS Foundation Trust,
capture responses of all IBD services in the UK. We London, UK
17
Department of Gastroenterology, St George’s University of London, London,
were, however, able to reach out to approximately UK
70% of UK IBD services who registered for the recent 18
Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK
19
unit and patient assessment of services under IBDUK Gastroenterology, Addenbrooke’s Hospital, Cambridge, UK
20
Department of Gastroenterology, University Hospital Birmingham NHS
(https://​ibduk.​org/​services-​map). The epidemic is at Foundation Trust, Birmingham, UK
different stages across the UK, but as can be seen in 21
Department of Gastroenterology, Barts Health NHS Trust, London, UK
22
figure 4, we have good geographic coverage of the IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
country. It is possible that some of the most under-­
Correction notice This article has been corrected since it
resourced IBD services may also have been less likely published Online First. The author's name R Mark Beattie
to have someone available to complete the survey. has been corrected and ORCID ID has been added and the
acknowledgement statement has been updated.
Finally, the rapidly evolving nature of data and
guidelines relating to COVID-19 in IBD make future Twitter Nicholas A Kennedy @DrNickKennedy, Richard
Hansen @PaedsRH, Shahida Din @ShahidaDin1 and Philip J
assessment of service provision important to ensure Smith @DrPhilipJSmith
equitable access to high-­quality IBD care across the Acknowledgements The authors acknowledge Sue Protheroe
country. and Carla Lloyd for sending e-­mails to BSPGHAN members.

Kennedy NA, et al. Frontline Gastroenterology 2020;11:343–350. doi:10.1136/flgastro-2020-101520 349

 Colorectal

Frontline Gastroenterol: first published as 10.1136/flgastro-2020-101520 on 16 June 2020. Downloaded from http://fg.bmj.com/ on August 3, 2021 by guest. Protected by copyright.
Collaborators On behalf of the UK IBD COVID-19 working 9 Rubin DT, Abreu MT, Rai V, et al. Management of Patients
group (see appendix for details). with Crohn’s Disease and Ulcerative Colitis During the
Contributors The original project was conceived by SS and COVID-19 Pandemic: Results of an International Meeting.
the survey developed by SS, CWL, NAK, RH and LY. Analyses Gastroenterology 2020 (Published Online First: April 2020).
were performed by RH and NAK. The initial draft of the 10 UK Government. COVID-19: guidance on shielding and
manuscript was written by SS, RH, LY and NAK. All of the protecting people defined on medical grounds as extremely
remaining authors contributed to data collection and to further vulnerable - GOV.UK. Available: https://www.​gov.​uk/​
writing of the manuscript. The other listed contributors government/p ​ ublications/g​ uidance-o
​ n-s​ hielding-a​ nd-p
​ rotecting-​
performed data collection. All authors and contributors were
extremely-​vulnerable-​persons-​from-​covid-​19 [Accessed 28 Apr
given the opportunity to review the manuscript.
2020].
Funding The authors have not declared a specific grant for this 11 Alrubaiy L, Arnott I, Protheroe A, et al. Inflammatory bowel
research from any funding agency in the public, commercial or disease in the UK: is quality of care improving? Frontline
not-­for-­profit sectors.
Gastroenterol 2013;4:296–301.
Competing interests None declared. 12 Younge L, Mason I, Kapasi R. Specialist inflammatory
Patient consent for publication Not required. bowel disease nursing in the UK: current situation and
Provenance and peer review Not commissioned; externally future proofing. Frontline Gastroenterol 2020;doi: 10.1136/
peer reviewed. flgastro-2019-101354. [Epub ahead of print: 1 April 2020].
13 Kapasi R, Glatter J, Lamb CA, et al. Consensus standards of
Data availability statement Data are available upon reasonable
healthcare for adults and children with inflammatory bowel
request. Deidentified participant data are available by request
from the corresponding author. disease in the UK. Frontline Gastroenterol 2020;11:178–87.
14 British Society of Gastroenterology. Endoscopy activity and
This article is made freely available for use in accordance with COVID-19: Bsg and JAG guidance | the British Society of
BMJ’s website terms and conditions for the duration of the
gastroenterology. Available: https://www.​bsg.​org.​uk/​covid-​19-​
covid-19 pandemic or until otherwise determined by BMJ. You
may use, download and print the article for any lawful, non-­ advice/​endoscopy-​activity-​and-​covid-​19-​bsg-​and-​jag-​guidance/
commercial purpose (including text and data mining) provided [Accessed 27 Apr 2020].
that all copyright notices and trade marks are retained. 15 de Jong MJ, van der Meulen-­de Jong AE, Romberg-­Camps MJ,
et al. Telemedicine for management of inflammatory bowel
ORCID iDs disease (myIBDcoach): a pragmatic, multicentre, randomised
Nicholas A Kennedy http://​orcid.​org/​0000-​0003-​4368-​1961 controlled trial. Lancet 2017;390:959–68.
Richard Hansen http://​orcid.​org/​0000-​0002-​3944-​6646
16 Cross RK, Langenberg P, Regueiro M, et al. A randomized
R Mark Beattie http://​orcid.​org/​00000003-​4721-​0577
Christopher A Lamb http://​orcid.​org/​0000-​0002-​7271-​4956 controlled trial of telemedicine for patients with inflammatory
Philip J Smith http://​orcid.​org/​0000-​0003-​1568-​3978 bowel disease (TELE-­IBD). Am J Gastroenterol 2019;114:472–
Peter M Irving http://​orcid.​org/​0000-​0003-​0972-​8148 82.
Shaji Sebastian http://​orcid.​org/​0000-​0002-​3670-​6545 17 Atreja A, Khan S, Rogers JD, et al. Impact of the mobile
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350 Kennedy NA, et al. Frontline Gastroenterology 2020;11:343–350. doi:10.1136/flgastro-2020-101520