ICS respiratory review successes - access to care

In this section you’ll find a wide variety of activities from working with addiction clinics to starting a virtual ward. 

Bath + North East Somerset, Swindon + Wiltshire

Swindon Pulmonary Rehab Service (GWH) Swindon.  Since April 2022 the Swindon PR service has worked on a long-term plan to reduce the service waiting times (some were waiting 2 years before), to meet the waiting time KPIS, to reduce barriers to engaging with PR and to reduce DNA rates. Heading into April 2024 all patients on the waiting list have been invited to an opt-in day where they have the opportunity to meet the team, engage with PR and decide if they are ready to commit. If they wish to attend, they will be offered an assessment for the next course.  

Average waiting time is currently 12 weeks, with max being 23 weeks (one patient) and min being 9 weeks, and median being 12 weeks. 

The Swindon PR team has achieved this through doubling capacity for face-to-face PR, increasing staffing support for PR using the BSW funding, increasing venue use through BSW funding.

By promoting the PR pathway of attending an opt-in day initially this has helped patients to make informed decisions about engaging with PR and offers opportunities to reduce patient barriers such as fear and anxiety around attending and other options such as attending the online course instead or taking some information booklets around symptom management for various lung conditions and taking away contact details to seek re-referral after a period of contemplation. This is reflected in the reduced DNA rates to attending PR assessment by 25%. This has supported attendance to assessment and course, on the most recent course there was 100% attendance to assessment day and 90% attendance to the course.

Buckinghamshire, Oxfordshire + Berkshire West

Most impactful intervention: Integrated Severe Asthma Care (ISAC) Project working with 6 PCNs in more deprived areas to identify and review patients with severe asthma and get them quicker access to tertiary severe asthma care and biologics.

Most impactful intervention: Oxford Breathlessness Pilot (Nov 2023-Mar 2025) – enabled streamlined diagnostics and MDT review/diagnosis for breathless patients in Oxfordshire.

CORE20PLUS5 – Winter 2023/24 project increased uptake of Covid-19 vaccination in immunocompromised and at-risk populations in BOB, inclusive of people with COPD and learning disabilities. An additional 270 people received Covid-19 vaccination over a period of six weeks. It included working with refugee centres, food banks and drug and alcohol addiction clinics, as well as vaccinating several housebound patients in their home.

Cheshire and Merseyside 

New programme for PR with digital offering and launch of Place by Place accreditation of services.

Dorset

We are planning projects in 3 PCNs (2 deprived, 1 rural) over the next year to support more proactive asthma and COPD care including to promote PR referrals and target people with high asthma exacerbation rates.

Frimley

• Development of sleep services and group work for CPAP.
• Started Nepalese group – to engage in PR also screen for diagnostics COPD.
• Just about start homeless project for PR access and COPD.
• Talking with Broadmoor re: specialised clinics for respiratory and establishing a form of PR. 

Hampshire and Isle of Wight ICS

Most impactful intervention:  NHS Hampshire and Isle of Wight commissioned spirometry in primary care via a Locally Enhanced Service (LES). Consistent access to spirometry in primary care has increased the number of tests which will be carried out. It is estimated that around 15,000 spirometry tests will take place in 2024/25 in primary care.  Spirometry in Community Diagnostic Centres. Increasing capacity and access to spirometry has increased the number of tests which will be carried out. It is estimated that over 4,000 spirometry tests will take place in 2024/25 in community diagnostic centres.

Asthma friendly schools. Support for children’s spirometry in primary care. The integrated care system is part of the Asthma Friendly Schools programme. The Asthma Friendly Schools programme sets out clear, effective partnership arrangements between health, education and local authorities for managing children and young people with asthma at primary and secondary schools. Becoming an Asthma Friendly School means that schools will have the following in place:

• Register of all children and young people with asthma.
• Management plan for each child (or a school wide emergency asthma plan)
• Named individual responsible for asthma in each school.
• Policy for inhaler techniques and care of the children and young people with asthma.
• Policy regarding emergency treatment.
• System for identifying children who are missing school because of their asthma or who are not partaking in sports or other activities due to poor control.

This guide enables schools to manage children and young people with asthma effectively in the pre-school, early years, primary and secondary school setting. It includes templates and checklists to practically support schools to become asthma friendly. Progress against the programme is monitored through the Hampshire and Isle of Wight Children and Young Person’s Asthma Network.

Humber and North Yorkshire

Supporting COPD self-management and support during exacerbations.

• Respiratory virtual ward programme
• Digital supported self-management (DYNAMIC-ROSE)

COPD case-finding.

• FRONTIER Programme

Supported access to pulmonary rehab.

• @Home programme - the Ridings Medical Group

Kent + Medway

Most impactful intervention:  Our CYP asthma campaign, saferasthma.co.uk and our asthma-friendly schools work in Medway has been really beneficial. 

North Central London

Most impactful intervention:  Accurate diagnosis: When restarting the service in late 2023, we identified a high-risk cohort of adult patients. We worked with primary care to set up Respiratory Diagnostic Hublets where this cohort could get tested. This was to address the number of both the undiagnosed and the misdiagnosed. This project enabled NCL to work as an ICS bringing in all partners for all levels of care. It helped us create stronger links between ICB, primary care, secondary care, community health providers and the CDC. We are moving towards a PCN or neighbourhood model, bringing care closer to patients’ homes while ensuring the highest standards of care. The establishment of designated RDHs as part of the patient pathway, significantly simplify each provider’s role within this and minimises misallocation of system resources. It will also be the first time we are able to consolidate a diagnostic service for both CYP and adults.

South East London

Most impactful intervention:  Accurate Diagnosis: 2 boroughs within SEL developed a successful bid for a respiratory diagnostic pathway for adults and children through a partnership between secondary and primary care where there had previously been inequity in service provision across the 2 boroughs.    

Respiratory Diagnostic service provision within an addiction clinic to enable diagnosis of those patients that do not access healthcare in the traditional way.