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Respiratory

Respiratory

Respiratory disease affects one in five people in England and is the third biggest cause of death.

Hospital admissions for lung disease have risen over the past seven years at three times the rate of all admissions generally and remain a major factor in the winter pressures faced by the NHS.

The NHS Long Term Plan over the next ten years will target investment in improved treatment and support for those with respiratory disease, with an ambition to transform UK outcomes to equal, or better, than international counterparts.

The NHS will do more to detect and diagnose respiratory problems earlier. Currently around a third of people with a first hospital admission for a COPD exacerbation have not been previously diagnosed.

The NHS will do more to support those with respiratory disease to receive and use the right medication. 90% of NHS spend on asthma goes on medicines, but incorrect use of medication can also contribute to poorer health outcomes and increased risk of exacerbations, or even admission.

Core20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement, one of which is Chronic respiratory disease.

Respiratory – Asthma

NSHI are committed to reducing health inequality and reducing variability of patient outcomes which remain a challenge in today’s NHS.

Identifying people with poor symptom control and at future risk of asthma attacks enables targeting of care. Targeting care on people/populations identified as being poorly controlled or at greater risk of asthma attacks has the potential to improve the quality of life of people with asthma and their families.

NSHI implement services, which focus on helping the practice to review this group of patients, by providing a respiratory specialist nurse to deliver:

  • Patient identification and therapeutic review
  • Clinical review of patient cohorts
  • irrespective of a F2F or remote consultation, ensures patients receive optimal treatment following a clinical assessment.
  • HCP Education (incorporating RCGP accredited modules) and mentorship
  • Guided Consultation
  • Accurate Diagnosis
  • Improved Lives

Respiratory – Difficult And Severe Asthma

Whilst it is widely recognised that there is a high variability in relation to the implementation of asthma guidelines across the UK, this is perhaps most apparent when we look at the management of patients with difficult and severe asthma.

There are two factors that need to be addressed:

1.Practices are only referring less than a quarter of patients considered as ‘high risk’ in relation to the NRAD recommendations (Bloom ERS 4274)

2.Some patients are being referred inappropriately. This has resulted in extensive waiting lists in the UK for a specialist review, in some instances up to a year, and therefore making it more difficult for patients with severe disease to be managed effectively.

NSHI implement services were the NSHI Respiratory Specialist Nurse works alongside the existing asthma clinical team, to support the work up and review of asthma patients referred from primary care to secondary care in order to differentiate between difficult and severe asthma patients who will then be managed in line with the centre’s existing protocols.

This will enable patients with severe asthma to be seen by the centre in a reduced timeframe and the difficult asthma patients to be referred back to the practice with an appropriate action plan in line with national/locality guidelines.

Many patients referred into the Specialist Asthma Centre, may not have been adequately worked up prior to referral and these patients are likely to require a thorough review prior to deciding their individual management plans.

Respiratory – COPD

People with chronic obstructive pulmonary disease (COPD) often have other chronic diseases and long-term conditions.

Comorbidity is one of the most important issues facing health systems in the world today and the single disease approach is unable to address this problem appropriately.

COPD is one of the three leading contributors to respiratory mortality in developed countries such as the UK.

In the future, general practice should play a pivotal role in the delivery of high quality care to people with long term conditions as part of a shared care model in which responsibility is distributed across different teams and settings.

Core20PLUS5 is an NHS England and NHS Improvement (NHSESI) approach developed by the Health Inequalities Improvement Team to support NHS Integrated Care Systems (ICSs) to reduce health inequalities.

Core20PLUS5 sets out five clinical areas of focus, one of which is Chronic Respiratory Disease: a clear focus on Chronic Obstructive Pulmonary Disease (COPD) driving up uptake of Covid, Flu and Pneumonia vaccines to reduce infective exacerbations and emergency hospital admissions due to those exacerbations.

NSHI are committed to reducing health inequality and reducing variability of patient outcomes which remain a challenge in today’s NHS.

NSHI implements services, in line with the NHS RightCare approach, which supports Health Care Professionals to standardise clinical care, implement national and local guidelines and provide cost effective care which improves patient outcomes.

Providing a respiratory specialist nurse to deliver the following:

  • Patient identification and therapeutic review
  • Clinical review of patients with COPD in line with NICE guidelines/GOLD Report/Locality guidelines
  • F2F consultations incorporate diagnostics, which cannot be undertaken remotely
  • Vitalograph copd-6 monitor used for all patients seen in clinic where last recorded FEV1 >6 months
  • Spirometry as required
  • Lifestyle counselling e.g. weight management, advice on stopping smoking (F2F & remote review)
  • Education (incorporating RCGP accredited modules) and Nurse mentorship
  • Guidelines recommend that inhaler technique should be checked at every review and whilst this is possible to carry out at F2F and VC reviews, it is not possible on telephone consultations

These therapeutic review services, irrespective of a F2F or remote consultation, aim to ensure that patients receive optimal treatment following a clinical assessment.

Our work has appeared in the NHS White Paper, Respiratory Medicine (GIRFT Report), The case study on Page 90 relates to the LungHealth software, which is a CE Class 1 medical device: 10854, ORCHA certified, (OBR Accreditation) score for Data Security 93%, with overall score of 68% leading to Web Application Accreditation. LungHealth is available on the NHS Procurement Platform. This healthcare technology was utilised across BLMK CCG as part of one of these services.

Additionally, BTS Futures Case Study; computer guided consultation software for copd reviews | Respiratory Futures – working together for better lung health