Team work, cross service collaboration and the importance of networks were key themes in responses we received from Integrated Care Systems.
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.
Bristol, North Somerset + South Gloucestershire
Most impactful intervention: Health Innovation Network's work with General Practice to start FeNO testing. LMC/ICB Training hub working to restart spirometry. Funded equipment and improved access to education.
Most impactful intervention: BNSSG Respiratory Interest Group and General Practice Respiratory Peer Support.
Rejuvenated spirometry in General Practice. Resources developed for Primary care staff. Training programme available.
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: BOB ICS Integrated Respiratory Delivery Network and its working groups coordinate/deliver the BOB ICS Respiratory Programme.
Primary Care Respiratory Survey – good feedback from primary care enabling understanding of respiratory confidence and support required for primary care. Informing integrated care model.
Cheshire + Merseyside
Most impactful intervention: Development of asthma and sleep pathways bringing together individuals across the pathway.
Linking TLHC CT scans with spirometry in TLHC sites from April 2024. Securing funding from Pharma for clinical review of patients post-spirometry in key target Place with greatest backlog of diagnosis. RN delivered education programme for late 2024.
Devon
PCN Respiratory Champions. During 23/24 NHSE funded 23 PCN Respiratory Champions across Devon. Projects undertaken by the Respiratory Champions included: COPD and Asthma Diagnosis and Management; Treating Tobacco dependency; Breathlessness; Respiratory infections and antibiotics; Optimising Pulmonary Rehabilitation capacity and Leadership skills.
Nurses undertaking the Respiratory Champions roles reported that in addition to increasing their Respiratory Disease expertise and knowledge, they improved their quality improvement skills and improved communication about Respiratory Disease within the PCNs.
Although the Respiratory Champion roles are no longer funded, the Respiratory Champions across Devon have remained in contact and continue to promote respiratory projects within Primary Care.
Dorset
Most impactful intervention: The development of the Dorset Insight and Intelligence service PHM database enabling us to see granular data of processes and outcomes across the ICS. We have managed to reduce SABA overuse significantly. We are planning to use it to address asthma exacerbation rates and smoking and PR in COPD.
Having a functioning ICS respiratory network with respiratory as one of the 3 priorities for transformation is important and having a team of PCN-based respiratory champions and easy data access to assess priorities and effectiveness are essential.
Frimley
Most impactful intervention: Integration of 2 teams into 1.
Most impactful intervention: Development of sleep services and group work for CPAP.
Most impactful intervention: Approval for joint working for severe asthma.
Establish MDT with asthma PC and secondary care.
Greater Manchester
Most impactful intervention: Spirometry and FeNO - We have been leading a piece of work to get spirometry and FeNO commissioned. This has met barriers after barriers. The work done however has managed to restart spirometry in all but one locality in GM. There is now a task force set up with senior commissioning and finance colleagues to get this into GM Commissioning intentions. The work done has already put spirometry and FeNO in the Joint Forward Plan, Primary Care Blueprint Implementation Group, and also within Diagnostics and Pharmacy Partnership Group.
Respiratory Deep Dive done across GM has given respiratory some momentum and a respiratory oversight group has been set up to oversee programs to do with Early and Accurate Diagnosis, Pulmonary Rehabilitation, Asthma and COPD, ILD and sleep.
Hampshire + Isle of Wight
Clinical Practice Educator: Children and Young People with Asthma. NHS Hampshire and Isle of Wight fund a clinical practice educator. This person provides mentoring to respiratory nurses in practices to support them to deliver paediatric spirometry and promote best practice in paediatric asthma care.
Asthma + Lung UK (A+LUK) respiratory champion role in place to increase primary care review of exacerbating patients. The integrated care system were one of six successful integrated care systems to work collaborative with A+LUK for a respiratory champion to be funded 1-day per week to promote better respiratory care and outcomes. The recent respiratory champion landscape report identified an area of opportunity to optimise care and outcomes for people living with asthma and COPD was to optimise the annual review process in primary care. Currently, these are often happening on the patient’s birthday month, rather than at the time of highest clinical need such as after an exacerbation of the person’s asthma or COPD when they need it most. The respiratory champion will lead on the development and implementation of a new primary care process for annual reviews.
Humber + North Yorkshire
Respiratory Champions Networks
- development of clinical networks of primary care HCPs interested in respiratory care.
- aims to support CPD, sharing of best practice and scaling QI programmes.
Lancashire + South Cumbria
Most impactful intervention: Morecambe Bay Respiratory Network.
LSC approach to providing collaborative quality assurance across primary and secondary care.
Norfolk + Waveney
Development of integrated respiratory service - although not in place the process has led to a significant improvement in working relationships between Acute and ICB.
North Central London
Ambitions to link to Long Term Conditions Locally Commissioned Services (LTC LCS) plan, as part of an innovative proactive care plan.
North East London
A remunerated clinical lead to continue the CYP practitioner role long-term and a remunerated consultant clinical lead. A ratio for CYP to CNS.
North East + North Cumbria
Most impactful intervention: The CYP team: systemwide education-based intervention, uptake of elearning for health training (National Competency Framework), primary care webinars delivered and focused interventions (GP practices and pharmacy work done by the community advisors).
Somerset
Most impactful intervention: We do very well in terms of hospital admissions, mortality and prescribing at a national level despite our rurality, deprivation and limited resources. We are quite often in the top 10% - this we believe is due to good working across boundaries and dedication of clinicians and managers to deliver the best care they can.
ARI Hubs are developing; we have good nebuliser guidance and shared guidance to encourage clinicians never to switch patients’ treatment without discussion.
There is a huge enthusiasm from generalist and specialists and we have had a Respiratory Programme Board now for more than 20 years.
South East London
A comprehensive COPD Guideline covering the entire patient pathway for use across primary and secondary care.
West Yorkshire
Most impactful intervention: Pairing with the ICST in Wales and providing a digital respiratory educational platform for everybody in primary care https://wyh.icst.org.uk/ Monthly lunch and learn.
Note: review dates refer to the page content rather than the data visualisations