BMC Public Health 2006, 6:3 http://www.biomedcentral.com/1471-2458/6/3 ical disciplines leading CSPs may have contributed to the relative lack of co-ordination in care and the low aware- ness of Hepatitis C in the UK. Recent national initiatives may have gone some way to improve this situation and should be built on to provide a cohesive national service for people with CHC. Models of best practice were identi- fied by this survey (data not presented), the salient feature being coordination and cooperation between the relevant specialities and settings in a locality involved in managing people with CHC.[23] The variation in management strat- egies including treatment despite national standards of care may also be well served by increased cohesion of serv- ices locally and nationally, with the aim to have a consist- ent high quality evidence based service delivered to patients with CHC no matter where they live. Staff capacity was identified as a major barrier to care, with all aspects of a CHC service needing additional resources. As the number of patients with advanced liver disease due to CHC grows, this will become ever more pressing with major implications for health care commis- sioners and providers with respect to recruitment, training and funding of specialised hepatology staff. Although there has been no co-ordinated policy driving service configuration, there was a CSP in virtually all Eng- lish SHAs, and in many Welsh and Scottish health dis- tricts. These centres provide the potential for building managed clinical networks based on populations of around 1–2 million as recommended by national poli- cies. Such networks could act to ensure national standards and equity of access to services, working together across localities and coordinating services across the country. CSPs should be developed within each network with a critical mass of staff, clear referral guidelines, outreach arrangements, and a unified information system to sup- port these networks and to monitor service performance. The early establishment of a comprehensive computerised IM&T strategy is needed as a matter of some urgency. It is encouraging that many of the CSPs were collecting homogenous data on CHC patients, however there was variation in the computer systems used and many units were unable to put data on to electronic systems due to lack of staff. Commissioners of HCV services will need to assess the population need in their area, which will be driven pre- dominantly by local IDU prevalence (current and ex), including that within the local prison population [24,25]. Targeting of high risk groups such as IDUs in prisons has been shown to be not systematised, with this survey reporting only 17 CSPs who had collaborative links or outreach clinics in prisons out of a total of 158 UK prisons [26-29]. More effort is needed to access this hard to reach population whilst they are detained, with risk minimisa- tion, case finding and treatment of eligible people. More research is needed to evaluate models of delivery of Hep- atitis C services to prisoners, both in prison and after their discharge. Limitations to this survey include inaccuracies in the pro- fessional lists used to sample participants. Whilst this may have led us to miss specialist centres, coverage appears to be good. Hepatology is not yet recognised as a specialty, and we had to assume that those clinicians belonging to national specialist groups have an interest in liver disease and we used this as a definition of hepatologist. The quan- titative responses were self -reported and may not have been derived from accurately recorded sources. Using the DIP and CSP classification was imperfect as several DIPs reported fluidity between categories depending on exter- nal factors such as resources. Conclusion This survey has examined how individuals are identified, diagnosed and treated. It has shown that there is inequity and variation in the management of people with CHC in the UK, with staffing and funding of treatment as key bar- riers to care. However, based on existing specialist centres identified by this survey, there are opportunities to pro- vide planned care via managed clinical networks sup- ported by a national information strategy. Urgent investment is needed to improve the identification, refer- ral and management of people with CHC, and to maxi- mize the opportunities to reduce the sequelae of serious liver disease. Competing interests The author(s) declare that they have no competing inter- ests. Authors' contributions JP and BBL designed the questionnaire, carried out the survey JP performed data analysis and wrote the first draft of the paper BBL conducted the follow up of non returns, performed data entry, provided administrative support to the study, and contributed to writing the paper PR provided expert epidemiology and public health input, supervised the work, and contributed to writing the paper WR conceived of the study, provided clinical expertise, supervised the work and contributed to writing the paper All authors read and approved the final manuscript. Page 8 of 9 (page number not for citation purposes)