1.  When will the TLHC Programme be in my area?

Targeted Lung Health Check (TLHC) Programme Roll Out Plan

Practices are being contacted by their local Place/ICB on a rolling programme to get ready for sending eligible patient demographics (aged 55-74 and ever smoked) to Liverpool Heart and Chest Hospital (LHCH), the commissioned provider delivering lung health checks and low dose CT scans for the TLHC Programme.  More info about the programme here.  This process happens around 3-4 months before your patients start to be invited for screening, so please continue to respond to these direct communications as you receive them.

Liverpool Heart and Chest Hospital will then coordinate sending of patient invite letters as per the schedule below.

Please click on the image below to view a table showing the high-level dates for when the TLHC programme will be live in the areas of Halton, Knowsley and Liverpool Places:

Table updated as at 06/10/22

Next steps after the programme has finished in your area:

Please be aware that the TLHC team will book follow up scans for those with lung nodules identified on CT (3- or 12-month repeats), and also a 24 month repeat scan for those with normal/no significant CT findings on the first scan as per national protocol.

2.  Scan findings: Actions required by General Practice and actions undertaken by LHCH – i.e. the clinical pathway

The following attachment shows the clinical pathway for the TLHC programme.

LHCH will review all CT results. This will be in line with their standard MDT protocols, and where appropriate, cases will be discussed by the Low Dose CT MDT. LHCH will action all significant abnormal CT findings, including lung cancer and lung nodules onward referral.  The only CT findings to be passed back to GP Practices will be non-urgent incidental CT scan findings, and LHCH will provide advice to Practices.    CT reports will be available to Practices via the EMIS shared record, and Practices will also receive a letter from the TLHC team.   

3.  How to book a TLHC inflammatory consolidation follow up CT 

As the patient’s GP you will receive a letter asking you to arrange a follow up Chest CT at 3 months.

On receipt of this letter, the GP should request this using RLUH ICE.

(Radiology for appropriate site > CT tab >GP CT Lung Health check f/up)

Please be prepared to enter the date the CT is due.

The patient will have been told by the TLHC nurse that the follow up will be arranged in 3m.

Radiology will contact the patient directly re appointment nearer the time.

The GP is responsible for booking the CT and actioning this CT result. Please consider practice safety netting.

Any queries re TLHC:

Tel: 0151 254 3032 (9-5 Mon Fri excl. bank hols)

Email: tcc-tr.lunghealthchecklhch@nhs.net

Website: https://www.lhch.nhs.uk/our-services/lung-health-check/

THLC consolidation Pathway for information

Patient has at CT as part of the Targeted Lung Health Check Programme (TLHC) which shows

Consolidation which appears inflammatory.

1. TLHC Nurse telephones the patient to advise the patient to contact GP/111/AED for review and appropriate treatment.
2. THLC nurse informs GP by letter and TLHC admin rings the GP surgery.
3. The CT is discussed at TLHC MDT.
4. After TLHC MDT, the THLC nurse sends ‘GP Consolidation outcome letter’ via EMIS direct messaging.
5. GP to order follow up CT for 3 months as above.

Oct 2021 review Oct 2022

Cancerteam@liverpoolccg.nhs.uk

LUNG HEALTH CHECK PROJECT TEAM letter will say:

ICE  > Radiology >GP CT > GP Lung health check f/up GP, the attached leaflet is linked to the ICE Request.

4.  Coronary Artery Calcification Advice and Guidance

If the patient is known to have coronary artery disease (previous myocardial infarction, abnormal coronary angiogram, coronary angioplasty or stenting or coronary artery bypass grafting) and is already taking secondary preventative measures, no further action is necessary.

If the patient has no prior diagnosis of coronary artery disease, they should be offered an appointment in primary care to discuss any symptoms and review their risk factors for coronary artery disease.

1. Asymptomatic with mild/moderate calcification

Coronary artery calcification indicates established atherosclerotic coronary artery disease, though it may not be causing any obstruction to blood flow. In these patients the mainstay of treatment is medical. Asymptomatic patients with mild or moderate coronary calcification should have their risk factors treated according to standard primary prevention guidelines (NICE CG 181).

2. Asymptomatic with severe calcification

If the calcification is described as severe, we would recommend using secondary prevention guidelines and targets, starting atorvastatin 80mg and aspirin 75mg. Consider beta-blockers and ACE-inhibitors to control blood pressure. Referral is not required to secondary care so long as the patient has reasonable exercise tolerance and is asymptomatic. Patients whose exercise tolerance is significantly limited for any reason should be referred for further assessment.

3. Symptomatic patients

Patients with symptoms of exertional chest discomfort should be referred for a routine cardiology clinic appointment through ERS, unless they have recent (within the last six weeks) onset of symptoms, or rapidly worsening symptoms, in which case they should be referred to a rapid-access chest pain clinic. All symptomatic patient should be started on aspirin 75mg OD, atorvastatin 80mg, bisoprolol 2.5mg OD and GTN spray PRN (unless there are contra-indications) and given safety-netting advice about action to take in the event of unexpected or prolonged chest pain.

Patients who would not be fit for cardiac surgery because of severe comorbidity or other life-limiting diagnoses need not be referred for assessment.

Previous Coronary Artery Calcification Advice and Guidance is archived for GPs here.