This paper is written by IMPRESS, a joint initiative between the British Thoracic Society (BTS) and the General Practice Airways Group (GPIAG) for improving and integrating respiratory services in the NHS. It is for clinicians, managers and commissioners who have a stake in the development of high quality respiratory care.
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 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.
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
Sleep apnoea services
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); the BTS has produced a service specification for sleep apnoea and CPAP provision. It has been endorsed by the patient support organisation, the Sleep Apnoea Trust Association and the GPIAG.
Click here for the BTS page including fact sheets, service specifications and press releases.
NICE guidance can be found here.