BMC Public Health Research article Variation in Hepatitis C services may lead to inequity of heath-care provision: a survey of the organisation and delivery of services in the United Kingdom Julie Parkes*1, Paul Roderick1, Bethan Bennett-Lloyd2 and William Rosenberg3 BioMed Central Open Access Address: 1Public Health Sciences & Medical Statistics (805) Level C, University of Southampton, Southampton General Hospital, Tremona Road, Southampton UK, 2Wellcome Trust Clinical Research Facility, Southampton General Hospital, Tremona Road, Southampton UK and 3Southampton Liver Group, University of Southampton, Southampton General Hospital, Tremona Road, Southampton UK Email: Julie Parkes* - jules@soton.ac.uk; Paul Roderick - pjr@soton.ac.uk; Bethan Bennett-Lloyd - B.D.Bennett-Lloyd@soton.ac.uk; William Rosenberg - wmr@soton.ac.uk * Corresponding author Published: 10 January 2006 BMC Public Health 2006, 6:3 doi:10.1186/1471-2458-6-3 This article is available from: http://www.biomedcentral.com/1471-2458/6/3 Received: 27 June 2005 Accepted: 10 January 2006 © 2006 Parkes et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Chronic hepatitis C infection (CHC) is a major healthcare problem. Effective anti- viral therapy is available. To maximise population effectiveness, co-ordinated services for detection and management of patients with CHC are required. There is a need to determine patterns of healthcare delivery to plan improvements. A study was conducted to determine workload, configuration and care processes of current UK services available to manage patients with CHC. Methods: A cross-sectional questionnaire survey of consultant members of British Association for the Study of the Liver (n = 53), Infectious Disease consultants (n = 43), and a 1 in 5 sample of Genito-Urinary Medicine (n = 48) and gastroenterologists (n = 200). Results: Response rate was 70%. 40% of respondents provided a comprehensive service (included treatment and follow-up): speciality of clinical leads identified as Hepatology (37%); Gastroenterology (47%); and Infectious Disease (16%). The estimated number of patients managed by respondents was about 23,000 with an upward trend over the previous 3 years. There was variation between comprehensive service providers, including unit size, eligibility criteria for treatment, and drug regimes. Key barriers to quality of care identified were staffing capacity, funding of treatment and patient non-attendance. Most English strategic health authorities had at least one comprehensive service provider. Conclusion: There was significant variation in all aspects of the patient pathway which may contribute to inequity of health care provision. Services need to be expanded to form geographical clinical networks, and properly resourced to ensure greater uptake and more equitable delivery of services if the future burden of chronic liver disease is to be reduced. Background Chronic Hepatitis C (CHC) is a major cause of serious liver disease[1,2]. Effective viral eradication therapy using combinations of anti-viral agents is available [3,4] and Page 1 of 9 (page number not for citation purposes)