British Thoracic Society homepage click here or on logo in the top right of the IMPRESS page
General Practice Airways Group homepage click here or on logo in the top right of the IMPRESS page
We would recommend the Kings Fund online reading rooms as a source of background material. Click here.
1. Understanding NHS policy and targets
http://ratings2006.healthcarecommission.org.uk/Indicators_2006Nat/Downloads/PCTList.pdf
2. Commissioning
General:
NHS documents (NHS Commissioning Framework - online and pdf
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Commissioning/index.html
Practice Based Commisioning Practical Implementation published 29 Nov 06 - very useful guide to how it will
work, audience: practices and PCTs.
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Commissioning/Practice-basedcommissioning/index.html
Commissioning Framework for Health and Well-being
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604
NHS Networks Commissioning homepage http://www.networks.nhs.uk/157.php
Comprehensive handbook from Melton Rutland and Harborough PCT (online and pdf)
http://www.primarycarecontracting.nhs.uk/uploads/pbc_files/october_06/pbc_handbook_june_2006_2.pdf
Improvement Foundation website; practice-based Commissioning:
http://www.improvementfoundation.org/theme/commissioning-healthcare-services/practice-based-commissioning-development-programme
Practice-based commissioning: From good idea to effective practice:
http://www.kingsfund.org.uk/publications/kings_fund_publications/practicebased.html
Commissioning for long term conditions
Unique Care (Management of patients with complex needs)
http://www.improve.nhs.uk/View.aspx?page=/topics/health/longterm_conditions/unique_care/default.html
Commissioning for long term conditions is a collaboration between Asthma UK, Diabetes UK and British Heart Foundation and has a website with a lot of useful resources:
http://www.commissioningforthelongterm.org.uk/
For the most detailed information on commissioning a long term condition, see the Diabetes commissioning toolkit by DH National Diabetes Support Team, Diabetes UK, PCDS, ABCD, Yorkshire and Humber Public Health Observatory
http://www.dh.gov.uk/assetRoot/04/14/02/85/04140285.pdf
[note that no Public Health Observatory has the respiratory lead]
Commissioning respiratory care
There is no site that deals with this specifically, but the resources here all have useful elements.
NEW! (02/06/08) Commissioning and Developing Home Oxygen Clinical Assessment and Follow Up Services from the Department of Health is available now. See this link.
3. Patient involvement
How to promote self care
http://www.wipp.nhs.uk/self-care
The Picker Institute works with patients, professionals and policy makers to promote understanding of the patient's perspective at all levels of healthcare policy and practice and has much new research and policy statements at http://www.pickereurope.org/
A valuable review of the evidence on patient-focused interventions Primer
http://www.pickereurope.org/Filestore/Downloads/Policy_Primer_Sept_07_3.pdf
or the full report http://www.pickereurope.org/Filestore/Publications/QEI_Review_AB.pdf
See also Angela Coulter's conclusion that whilst evidence that strategies to strengthen patient engagement are effective is substantial, any strategy to reduce health inequalities must promote health literacy
http://www.bmj.com/cgi/content/full/335/7609/24?ijkey=puwRPL3NPgfHgM6&keytype=ref
Public involvement: top tips
http://www.pickereurope.org/page.php?id=7
The NHS Centre for Involvement has a large resource section
http://www.nhscentreforinvolvement.nhs.uk/index.cfm
Involving patients, reconciling population based approaches and individual need,
Healthy Democracy book by Involve and NHS Centre for Involvement at Warwick,
http://83.223.102.125/involvenew/mt/archives/blog_37/Healthy_Democracy/Healthy_Democracy.pdf
www.nationalvoices.org.uk
(to be launched by end of September 2007)
NHS Choices -
www.nhs.uk
http://www.nhs.uk/conditions/Asthma/Pages/Questions.aspx?url=Pages/Questionstoask.aspx
Video of Peter Barnes talking on asthma
http://www.nhs.uk/conditions/Chronic-obstructive-pulmonary-disease/Pages/questionstoaskpage.aspx?url=Pages/Questionstoasktab.aspx
Featuring Keith Prowse on COPD
End of Life Care Strategy July 2008: NHS Website: http://www.endoflifecareforadults.nhs.uk/eolc/ DH website: http://www.dh.gov.uk/en/Healthcare/IntegratedCare/Endoflifecare/index.htm
Carers strategy: Carers at the heart of 21st century families and communities: a caring system on your side, a life of your own. Click here.
4. Risk stratification
Review of literature on predicting risk that concludes that clinical judgement alone is insufficient as there
is a regression to the mean.
http://www.kingsfund.org.uk/current_projects/predictive_risk/index.html
This link is to the predictive risk tool, PARR and PARR ++ used by an estimated 70% (estimated by Health Dialog, the supplier) PCTs now, in some form.
http://www.kingsfund.org.uk/current_projects/predictive_risk/patients_at_risk.html
This is the link to the combined predictive model that aims to identify prospectively those patients likely to be at very high risk of admission. It also uses more data sets than PARR so it can identify those along the whole continuum of risk.
http://www.kingsfund.org.uk/current_projects/predictive_risk/combined.html
5. Needs assessment
Data collection by providers
Data analysis by commissioners
Eliciting patient views and experience
NICE commissioning guides are available to commissioners (a password is required to access the spreadsheets, but everyone has access to the text) for assisted discharge
http://www.nice.org.uk/page.aspx?o=376706 and pulmonary rehabilitation
http://www.nice.org.uk/page.aspx?o=375968 for COPD patients
The criticism levelled at these is that they don't tell you the skillmix required as they focus in on patient-centred delivery. However, they are a useful start in terms of understanding the scale of the issue.
London Health Observatory links to respiratory datasets:
http://www.lho.org.uk/HIL/Disease_Groups/RespiratoryDisease.aspx
Other PHO data sets eg South West PHO
http://www.swpho.nhs.uk/resource/browse.aspx?RID=26 has admissions data for England, plus detailed PCT
and hospital trust data for the region for all respiratory, asthma, COPD, and pneumonia using HES data.
Improvement Foundation guidance based on the COPD collaborative and primary care access collaborative work
http://www.improvementfoundation.org/theme/long-term-conditions
SNOMED and other HRG coding discussions
http://www.connectingforhealth.nhs.uk/terminology/snomed
HES data and enquiry service from Information Centre:
http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=192
Self service HES
http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=654
Request a tailor made service (charge)
http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=468
Community health profiles by Public Health observatories:
http://www.communityhealthprofiles.info/
Health poverty index http://www.hpi.org.uk/
http://www.lho.org.uk/HEALTH_INEQUALITIES/Basket_Of_Indicators/BasketOfIndicators.aspx
6. Planning an intervention: the setting; shift to the community
For a review of the evidence about transforming chronic care, see University of Manchester's HMSC rapid review of transforming chronic care:
http://www.hsmc.bham.ac.uk/news/TransformingChronicCare.pdf
At the macro level, there are a number of interesting papers about integrated care. The best overview is from the NHS Confederation - review of evidence Building Integrated Care by Naomi Fulop et al that can be downloaded from their Integrated Care site
http://www.nhsconfed.org/issues/issues-2279.cfm
There is also a provocative and interesting opinion piece by Andy Black on the future of acute care published by NHS Confederation Nov 2006
http://www.networks.nhs.uk/uploads/06/12/thefutureofacutecarenhsconfed.pdf
One of the models that Andy Black and Naomi Fulop draw attention to, is the new Central Middlesex Hospital BECaD that has been built to improve integration and patient flow. For the respiratory model see
http://www.nwlh.nhs.uk/devprojects/documents/BrentRespiratoryModel.pdf
The NHS institute programme on shift that looks in detail at 5 field sites testing new approaches:
http://www.institute.nhs.uk/care_outside_hospital/care/care_outside_hospital.html
The shift to the community is predicted in a simulation by Office for Public Management (OPM) about the future of primary care (providing and commissioning): "primary care in the future will increasingly be defined as a setting rather than a level of specialisation.":
http://www.opm.co.uk/resources/papers/health/levers_contracts_choice.pdf
Options for primary care trust provider services: an evidence-based policy-analysis for NHS West Midlands. University of Birmingham School of Public Policy, Health Services Management Centre (HSMC). Nov 2006 downloaded at www.networks.nhs.uk prmary_care_provided_services_uob_nov06.pdf
Creating capacity in primary care: the WIPP programme
http://www.wipp.nhs.uk/1.php
Virtual wards - the intervention developed in Croydon PCT to respond to the application of the risk stratification process:
www.networks.nhs.uk/uploads/06/12/croydon_virtual_wards_case_study.pdf
7. Service improvement - quality and productivity
Understanding the tariff
Improving safety
Improving patient experience (no pain, good outcomes)
Understanding and improving patient flows
Reducing waste (delays, inefficient use of staff)
Improving equity
Designing sustainable pathways
Don Berwick's work for clinicians on the dimensions of quality (eg My Right Knee - Annals of Internal Medicine: http://www.annals.org/cgi/reprint/142/2/121.pdf
Payment by results, including the tariff:
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Financeandplanning/NHSFinancialReforms/index.htm
NHS Institute testing of improving flow and service transformation using Lean and 6 Sigma
http://www.institute.nhs.uk/quality_and_value/introduction/quality_and_value.html
The essential Improvement Leaders Guides
http://www.institute.nhs.uk/building_capability/building_improvement_capability/improvement_leaders'_guides
ISIP resources (Integrated Service Improvement Programme)
http://www.isip.nhs.uk/guidance/
Evidence from National Electronic Library for Health, Respiratory Section
http://www.library.nhs.uk/respiratory/
Examples from NHS Institute, NHS networks eg North West London Respiratory Network
http://www.networks.nhs.uk/networks.php?pid=320
Long Term Conditions pages in NHS Networks
http://www.networks.nhs.uk/3.php
Top tips on pathway design by NHS Confed/Improvement Foundation/RCGP
http://www.improve.nhs.uk/documents/Early wins and top tips.pdf
Cancer collaborative evidence on sustainable pathways that meet NSF targets
http://www.cancerimprovement.nhs.uk/View.aspx?page=/sustainability/pathways.html
Some of early thinking (2001) about building integrated networks around care pathways
http://www.opm.co.uk/download/papers/networks.pdf
Healthcare Commission review of tobacco control by PCTs 28/02/07
www.healthcarecommission.org.uk/serviceproviderinformation/reviewsandinspections
/improvementreviews/tobaccocontrol.cfm
8. Service specification
Primary care service frameworks - generic, comprehensive and enhanced service specification for PCT
commissioners and Practice Based Commissioners for 2007/08.
http://www.primarycarecontracting.nhs.uk/204.php
9. Networks
Cancer networks: http://www.cancerimprovement.nhs.uk/
Royal College of Paediatrics and Child Health: A Guide to Understanding Pathways and Implementing Networks - December 2006
It includes a guide to setting up networks.
http://www.rcpch.ac.uk/publications/recent_publications/Managed Networks.pdf
Scottish Managed clinical networks
http://www.nhshealthquality.org/
http://www.networks.nhs.uk/136.php
has links to all guidance papers and checklists on networks from Scotland and England. Neil Goodwin papers are good.
Nigel Edwards paper 2002 BMJ on PubMed
BMJ. 2002 January 12; 324(7329): 63
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1122027
10. Skill mix and competences
IMPRESS standards click here. There is a reference in the full document to practice nurse standards. These are published by the GPIAG here. They make reference to templates to support the consultation. There are a number available and the GPIAG is not prescriptive about which to use. As an example, the GPIAG template is available here. Information about the Scottish Programme for Improving Clinical Effectiveness in Primary Care (SPICE) templates for asthma and COPD here.
http://www.skillsforhealth.org.uk/page has all the information about competences including nationally agreed competence definitions and tools to create job descriptions based on competences.
Manchester's HSMC report on skillmix: http://www.hsmc.bham.ac.uk/LTCnetwork/
The duties, responsibilities and practice of physicians in general medicine and the specialties
Third edition 2005, general and respiratory chapter
http://www.rcplondon.ac.uk/pubs/brochure.aspx?e=17
http://www.rcplondon.ac.uk/pubs/contents/c7a46a2a-567b-4d52-b707-ff27aad58431.pdf
NHS Institute work on enhancing engagment in medical leadership
http://www.institute.nhs.uk/building_capability/enhancing_engagement/engagement_in_medical_leadership.html
11. Monitoring productivity and quality
The National COPD Resources and Outcomes Project NCROP
http://www.rcplondon.ac.uk/college/ceeu/ceeu_copd_home.htm
Healthcare Commission reviews (eg report on COPD - summary:
http://www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm?cit_id=4025&FAArea1=customWidgets.content_view_1&usecache=false
Full report:
http://www.healthcarecommission.org.uk/_db/_documents/COPD_report1.pdf
12. Respiratory specific sites
Home oxygen portal with sections for the NHS, healtcare professionals and patients, carers and the public
http://www.homeoxygen.nhs.uk/1.php
Smoking cessation
http://www.uknscc.org/2006_UKNSCC/presentations/alex_bobak_1.html
and
http://www.uknscc.org/index.html
Met Office forecasting COPD and Met Office forecasting - discussion thread and key contacts
http://www.networks.nhs.uk/forums/showthread.php?t=1902
Healthcare Commission Review No ifs, no buts Jan 2007
http://www.healthcarecommission.org.uk/_db/_documents/Tobacco_Control_improvement_
review_scores_for_public_by_local_area__All_England_-_SD.pdf
13. Healthcare for London - the Sir Ara Darzi Review
http://www.healthcareforlondon.nhs.uk