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 August 2012 the DH produced a suite of commissioning tools including service specifications for:

IMPRESS strongly urges commissioners to work locally with local stakeholders including clinicians and patients to consider the whole balance of investment in COPD care (see our work on value), to review what currently is provided, and to adapt these specifications 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.  See our  narratives about commissioners who have used a competitive process.

Although we use 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 andwww.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 andwww.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.phpThis 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

An IMPRESS sample service specification for COPD can be downloaded here.And see DH England service specifications here.

Pulmonary rehabilitation

IMPRESS has produced a document outlining key standards for pulmonary rehabilitation. Download document here

See full resource list for PR 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

Some primary care organisations are using the GMS option of a LES (to improve the provision of certain services in primary care. 

Islington, winner of one of the IMPRESS awards 2011, has now run a COPD LES for three years with a measurable improvement in primary care performance.  All three years of the LES can be downloaded from our publications.

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 is under review August 2012.  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

Lung cancer (June 2010)

The UK Lung Cancer Coalition has developed a toolkit to help clinicians involved in lung cancer care to engage with their local commissioners and make the case for improvements in lung cancer services.    It includes:

• Background on the UK Lung Cancer Coalition and its priorities for action
• Data on how each Cancer Network area performs on lung cancer, and how this compares to the rest of the country
• Contact details for local PCT commissioners of lung cancer services
• A template e-mail for lung cancer clinicians to use to approach their local commissioner for a meeting
• Things that clinicians may wish to consider when engaging with their local commissioner of lung cancer services, and advice on making their case as convincing as possible
• Links to other sources of information on lung cancer