Workforce and skillmix
IMPRESS has published key standards and competencies for respiratory care for commissioners (see below), highlighting what needs to be considered and specified in any respiratory service.
IMPRESS endorses a discussion paper on the role of the Integrated Care Consultant published by BTS. It also endorses the work by GPIAG on the accreditation and development of Practitioners with a Special Interest.
Click here for articles in the Primary Care Respiratory Journal and here for a link to the first article in British Journal of General Practice.
In the meantime, Skills for Health has produced a full dictionary of respiratory competences CHS67 Support individuals with long term conditions to manage their respiratory function Page 1 of 6 Final version approved March 2007.www.skillsforhealth.org.uk/page/. These can also be linked to the Map of Medicine work on pathways. The Map of Medicine is now available to all NHS staff — doctors, nurses, midwives, allied health professionals and trust managers in England and Wales. It requires registration. There are about 6 COPD pathways available.www.mapofmedicine.com/home.php
Key Standards for COPD Care, Management and Treatment – A paper for commissioners of care for people with long term conditions.
Executive Summary
Recent research and surveys suggest that there is significant variation in the competence of those delivering COPD care and that the current systems may not remedy this. A joint venture between the two leading clinical British Thoracic Society, and the General Practice Airways Group, IMPRESS, offers some broad standards of competence by which a service for patients with COPD could be judged. The focus is on function and outcome not on which profession does it. However it also stresses the importance of professional standards.
Questions for commissioners
- Who is accountable locally for ensuring that the workforce has the competence to deliver locally-specified respiratory care? Who takes responsibility for addressing any shortfalls in the short, and longer term?
- Who has the competence locally to judge whether performance is satisfactory?
- What evidence are you using to judge the mix of skills and disciplines you require? Do you have a local clinical multi-disciplinary network to advise you?
- Do you know what was spent last year on training and education in respiratory care? What do you expect to be spent this year? If the budgets are devolved to practices, how do you assure yourselves that the budget is allocated appropriately?
- Who is responsible for looking at the sustainability of the respiratory services?
- What discussions have you held about how to equip the system with the knowledge, skills and attitudes for delivering patient-centred care? How are patients involved in designing and delivering their care? What mechanisms exist for patients’ feedback to clinicians?
- What evaluation do you have in place to monitor that changes in skill mix and workforce are leading to positive improvements? Note: IMPRESS will be producing a proposed evaluation framework by the end of April.
- What are you doing to ensure that there is clinical leadership and engagement?
Standards and principles of COPD competences
- Patients should receive individualised care from knowledgeable practitioners experienced in COPD care.
- To ensure effective performance, COPD care should be delivered by a range of health care practitioners working as part of a multi-disciplinary team. Any mentally competent patient or member of staff should be able to name who leads the service.
- Integrated Care: patients should not see the joins, feel pulled in different directions, or be asked unnecessarily repetitive questions – their care should be seamless, continuous, appropriate and responsive no matter who provides the service and no matter how many co-morbidities the patient may have.
- Patient centred care: patients must be active participants in securing appropriate, effective, safe and responsive care
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