IMPRESS has written a detailed account of developing a service specification for clinicians, managers and commissioners who have a stake in the development of high quality respiratory care. To download a copy click here.
It takes people through the process of developing a service specification for respiratory care from the point of agreeing a shared vision, aims and objectives, to determining what should be included in the specification, what resources are available, and what form of procurement might be chosen.
It advocates the creation or further development of a clinical network that can provide expert advice and input on needs assessment, service models and care pathways as well as overseeing and supporting an appropriate training and development programme for the respiratory workforce, particularly those working in the community.
It also, at section 16, provides the structure and headings for a specification for Chronic Obstructive Pulmonary Disease (COPD), as an illustration.
In line with World Class Commissioning, IMPRESS strongly urges commissioners to work locally with local stakeholders including clinicians and patients to develop a specification appropriate to local circumstances. Whilst it acknowledges that some new services may need to be procured using a competitive process, it encourages clinicians, in collaboration with commissioners, to actively seek patient views and experiences, and to ensure that existing services meet the best evidence and their patients’ needs and preferences. This might require reallocation of existing budgets and redeployment of staff. This is preferable to the upheaval and cost (human and financial) involved in a competitive process.
Although it uses respiratory examples, many of the principles apply to other long term conditions and could be used as the basis of the approach for them all.
Primary care
There are some national framework documents to support the implementation of personalised care planning: Primary Care Service Framework: Personalised Care Planning for People with Long Term Conditions
and also see below for an example of a LES for COPD.
Asthma
The current standards of care for asthma management are outlined in the new revised 2008 British Guideline on the Management of Asthma [British Thoracic Society, Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. Thorax 63 2008; (Supplement 4): iv1-iv121. (www.sign.ac.uk/pdf/sign101.pdf and www.sign.ac.uk/guidelines/fulltext/101/index.html] and the NICE guidance [The use of inhaled steroids in the management of asthma (Adults: www.nice.org.uk/Guidance/TA138 and Children: www.nice.org.uk/Guidance/TA131 and www.nice.org.uk/guidance/index.jsp?action=byID&o=11945] on the use of inhaled steroids in the management of asthma.
In addition, the GPIAG has produced a A Quick Guide to the Routine Management of Asthma in Primary Care
www.gpiag.org/asthmaguide/asthma_guide_home.php
This toolkit is intended as an aide memoire for primary care health professionals to refer to in the course of a consultation and may be adapted for local use subject to authorised approval.
COPD
A sample service specification for COPD can be downloaded here.
Pulmonary rehabilitation
IMPRESS has produced a document outlining key standards for pulmonary rehabilitation.
Download document here
Oxygen
Oxygen: latest guideline from British Thoracic Society on home oxygen (for long term use)
Oxygen: latest (published Thorax Oct 2008) guideline from British Thoracic Society on emergency oxygen. This Guideline has received the endorsement and support of 21 organisations will lead to substantial changes in practice.
Primary care: Local Enhanced Service
June 2009: Some primary care organisations are using the GMS option of a LES (Jargon Buster) to improve the provision of certain services in primary care. Here is an example from NHS Tower Hamlets that aims to optimise the primary care management of COPD, and to embed it in a pathway. IMPRESS fully supports the initiative, although responsibility for the details are with NHS Tower Hamlets. In addition, here are the accompanying EMIS data collection templates for NHS Tower Hamlets with thanks to the authors: Clinical Effectiveness Group
Obstructive Sleep Apnoea Syndrome (OSAS)
March 2009: An IMPRESS guide to commissioning OSAS services can be downloaded here. This service specification represents the views and recommendations of the British Thoracic Society (BTS), Association for Respiratory Technology and Physiology (ARTP), General Practice Airways Group (GPIAG) and the patients' association the Sleep Apnoea Trust Association (SATA). It has grown from work that the British Thoracic Society did originally to coincide with the publication on 26 March 2008 of the NICE Health Technology Appraisal (HTA) of continuous positive airway pressure (CPAP) for obstructive sleep apnoea hypopnoea syndrome (OSAHS).
Click here for the BTS page including fact sheets, service specifications and press releases.
NICE guidance can be found here.
End of Life Care
IMPRESS believes that there there are deficits in the care of people with advanced respiratory disease that need to be addressed in all commissioners’ end of life strategies. IMPRESS highlights some of these in its responses here (Jan 2009) to the DH Quality Markers consultation (Click here). In addition, we have specifically designed an education programme to address possible deficits in communication about end of life issues in COPD. Click here