July 2012

North West Respiratory Clinical Pathway Team - winners from the 2012 awards, offering examples of good practice

Download the full report or see below for summaries

Respiratory Self Care - Wirral Health Commissioning Consortium
 Benefits:
WHCC are most proud of the fact that they are fully engaged in clinical commissioning by bringing up to date evidence to address the local needs from the JSNA (see Jargon Buster). As a clinical commissioning group they have demonstrated strong partnership working with both current providers and the introduction of new providers with new technology to improve clinical services (including non NHS). This co- operation empowers patient’s ability and knowledge in how best to self care.

Quick wins:

• Partnership working fostered collaboration, which was required to support the implementation of pathways

• Maintaining momentum kept everyone on track to roll out
• 
Patients supporting clinical commissioning
• Early results very promising
  
  
  

General Practice Respiratory initiative - Marus Bridge Practice, Health First ALW CIC

Benefits:

• Focus on improved diagnosis and management within General Practice for patients with conditions resulting in breathlessness
• Decreased numbers of acute hospital admissions and outpatients attendances for COPD patients when compared with the other consortia in the borough, representing savings of £90,000.
• 20% reduction in 0-1 day admissions 
• As a result of medication reviews, annualised savings of £40,000 in medicines management 
costs have been made.
• Prevalence has increased by 12.3% across the practices in ALPF consortium
• There is an increased number of people being diagnosed at a younger age than at baseline 
e.g. a 56% increase in diagnoses in the 36-50 age group.
• 63% increase in referrals to pulmonary rehabilitation  
• 20% increase in people calling themselves ex-smokers in comparison to baseline numbers

Quick wins:

Medicines management has proved itself to be a relatively quick win saving large amounts of money whilst improving quality and patient care. This has mainly taken the form of optimising and rationalising treatment- choosing cost-effective inhaler devices, putting people who were on separate ICS and LABAs on combined, stepping down mucolytics in COPD patients and ICS doses in asthma patients. All patients with medication changes had inhaler techniques checked with an Incheck dial and were reviewed after 4 weeks by a health care assistant. We made £40,000 worth of annualised savings in a 6 month period.

Respiratory Team of the Year - Integrated Respiratory Team, East Cheshire Trust/Central and East Cheshire PCT
Benefits:

• Managed 4207 referrals to the service
Reduced the oxygen prescribing budget by £207,271.58 within the first 16 months of service commencement

• Avoided the admission of 431 patients by supporting them at home as direct referrals saving 3017 bed days

• Supported the early discharge of 700 patients.
• Reduced the length of stay by 3 days for COPD at MCHFT & ECT saving 1625 bed days
• Managed 10 specialist respiratory & oxygen assessment clinics per week (5 Respiratory Specialist Nurse clinics, 2 first O2 assessment clinics and 3 review O2 clinics)

• Reviewed 849 patients in the community respiratory specialist clinics
• Reviewed 1317 patients assessed and reviewed for home oxygen

• Reviewed 443 patients < 2 hours
Reviewed 1334 patients within 24hrs

• Established a maintenance case load of 60 patients with severe and chronic lung disease and arranged 260 routine home visit reviews for these patients
• Established links with palliative care teams to assist in the provision of palliative care, hospice day care and hospice in-patient services for patients with end stage lung disease and supported 29 patients at the end of life
• Established links with local British Lung Foundation ‘Breathe Easy’ patient & carer support groups
• Established a joint working agreement with the respiratory pharmaceutical companies enabling the provision of education programmes across CECPCT for all health care professionals including pharmacists

• Developed and established weekly MDT with the Consultant Respiratory Physicians
• Established a respiratory support group

Quick wins:

• Education: The aim is to inform, liaise and up-skill the referring clinicians and those undertaking the review of respiratory. The education is evidence based and in line with local guidelines, pathways and national recommendations and aims to meet the needs of the locality. The educational sessions and informal meetings include the provision of educational updates, respiratory interest groups, educational meetings and mentorship where appropriate for all health care professionals including pharmacists.
• Be visible, approachable and accessible in primary and secondary care. A team will not be successful if it does not engage with its fellow colleagues.
• Voluntary agencies & Breathe easy Groups: patients have a very powerful and emotive voice and can often succeed in getting new services where clinicians do not.
• Understand the needs of your population and what the predicted needs are likely to be then get together an initial network project group inviting with the key individuals you feel will help you to engage the commissioners/GP consortia/acute trust

June 2011

IMPRESS Award winners for 2011

Two of the three winners focused on COPD.  The winner of category 1 - improving quality, was the MND Association that showed the impact the third sector could make on getting both a NICE guideline and then a change in policy introduced for the benefit of patients.

Category I Improving quality   
Winner: The role of the third sector influencing clinical practice in respiratory support MND Association


Download poster

March 2011

From Southend University Hospital  and NHS South East Essex. The PCT has commissioned a further extension of the COPD community scheme.  This will provide consultant-delivered outreach clinics for Respiratory Medicine in South East Essex. These will be locality based to cover the practice-based commissioning consortia areas bringing patient care closer to home. 

This service will also offer primary and community service providers the opportunities for clinical leadership, case management via Multi-Disciplinary Team (MDT) meeting and virtual clinic. This will improve the respiratory health of the local community in particular supporting care for patients with chronic respiratory disease with the aim of reducing A&E attendance, admissions, length of stay and will contribute to a shift of hospital outpatients activity to a community setting.

To read the commissioning case go here.   The COPD service provided by Southend was also highly commended in the Health and Social Care Awards, East of England in 2010.  To read the team's submission go here.

See previous years' awards here