www.england.nhs.uk 27/03/

2015

Bridging the gap

Respiratory Futures Webinar Debate No.3

27th March 2015

www.england.nhs.uk

Bridging the gap “a conversation”

GP Specialist

www.england.nhs.uk

Topics of “conversation”

• Communication

• Models of specialist provision

• Standardisation of patient information, self-management

tools etc.

• Care bundles across the sectors

• Early diagnosis tools

• Spirometry provision

• Resources to promote closer working

27/03/2015

www.england.nhs.uk

General

Practitioner

Specialist

Patient

Public funding

and public provision

Public funding

Increasing marketisation

www.england.nhs.uk

Barriers to access

Primary care Acute Trusts

GP Specialist

Care

Structural barriers?

Commercial barriers?

Professional?

Communication

• “Why don’t hospital OPD letters include hospital spirometry readings as a matter of course?”

• “And why will the secretary not send the information to me when I request it?”

• “Why don’t GPs send vital information in their referral letter?”

• Why don’t we have shared records?

Communication

• GP access to hospital letters on line

• GP access to on line X-ray results and films

• Hospital access to GP records

• GP clinical records systems electronic for decades

• How many hospitals also electronic?

• What do community teams use?

• What about social services, district nurses, etc?

SMPs

• Which asthma or COPD self-management action plan do

you use? Why?

• Do GPs, PNs, community teams and hospital teams use

the same plan? If not why not?

• Do they tie in with antibiotic guidelines?

• Same recommendation for length and dose of

prednisolone therapy?

www.england.nhs.uk

New Models of Care

• MCPs

• PACS

www.england.nhs.uk

New models of care

• Greater devolution

• More co-commissioning

• Maximising local planning

• Encouragement of new models of care

• Revitalising small hospitals

• Getting serious about prevention

• Empowering patients (PHBs etc.)

• Focus on success not failure

• Parity for mental health

• Greater efficiency

27/03/2015

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What will happen to general practice?

• More investment

• Move away from individual small practices

• Federations

• Multi specialty community providers

27/03/2015

www.england.nhs.uk

What will happen to acute trusts?

• Get smaller

• Less investment

• Less emphasis on urgent care

• Focus on elective and specialised care

• Closer working with primary care

• Gradual vertical integration

(Primary and Acute Care Systems )

Inreach, outreach?

• Understanding needs

• Respect

• Education

• Regular meetings

• Leadership

• Integration on various levels

• GP attends OPD and “audits” Mx and review

• Specialist allotted time in 1y care for specific purpose (MM)

• Tier 2 / GPSI

• Truly integrated posts and services (e.g. Sanford)

Effecting Quality in Practice

Equip and

Improvement tools

Improvement Tools

What worksheets are available?

• Reviewing asthma diagnosis in children

• Stepping down triple therapy in COPD

• Reviewing high-dose ICS in asthma

• Identifying undiagnosed COPD

• Assessing patients with advanced COPD

• Management of advanced COPD

• Identifying high-impact COPD

• Post-acute COPD care bundle

• Accurate diagnosis of COPD

• Post-acute asthma care bundle

BLF: 10 steps to best COPD care

• Diagnosis confirmed with lung function test (spirometry)

• I understand my COPD and my HCP has explained where to find info, advice and support

• I’m supported to manage my care & have agreed SMP

• Annual flu jab and 1 off pneumo jab

• Regular support & treatment to help me stop smoking

• Lifestyle, exercise, diet, pulmonary rehab

• I know what my meds are for and when to take them

• Inhaler technique

• Exacerbations – guided self management

• Regular, structured review

http://passport.blf.org.uk

High impact COPD patients

Walk the 7 steps to the

best asthma care

• Diagnosis

• Triggers and control

• Encouraged, supported and

actively involved in management

• Medicines and inhalers

• Written personalised action plan

• Review

• Healthy lifestyles

NW SHA Resp Team 2013

Good technique doesn’t just happen

Greater Manchester

Inhaler Technique Project

http://wires.wessexahsn.org.uk/video-series/inhaler-technique

www.england.nhs.uk

Thank you

www.respiratoryfutures.org.uk

www.england.nhs.uk

www.pcrs-uk.org

@respfutures