Integrated care in COPD – the Bath experience

1. Integrated care in COPD – the Bath experience Jay Suntharalingam Consultant Respiratory Physician, Royal United Hospital (RUH) Bath

2. Bath & North East Somerset (BANES) PCT

3. Where do intermediate care services fit in? Intermediate COPD service Secondary care Primary care

4. Intermediate care services - ‘teams without walls’1 Primary care IMPACT service Secondary care IMProving Access to COPD Therapies 1Royal College of Physicians, 2003

5. Intermediate care services - IMPACT Primary care IMPACT service Secondary care Accessible Experience Safe Integrated Quality assured Effective

6. IMPACT - staffing • 1 WTE Band 7 physiotherapist • 2 WTE Band 6 nurse • 1 WTE Band 6 physiotherapist • 0.5 WTE Band 3 rehab assistant • 1 WTE Band 3 administrator • 0.2 WTE Respiratory Consultant Primary care Secondary care

7. GP referral Oxygen assessment Early supported discharge I M P A C T Pulmonary rehabilitation Primary care referral Community COPD clinics Other community services Secondary care referral Medication optimisation Self referral

8. Bath COPD patients often have multiple admissions RUH data 2006/7

9. GP referral Oxygen assessment All hospitalised patients I M P A C T Pulmonary rehabilitation Primary care referral Community COPD clinics Other community services Secondary care referral Education & training for healthcare professionals Medication optimisation Self referral

10. GP referral Oxygen assessment Early supported discharge I M P A C T Pulmonary rehabilitation Primary care referral Reduced preventable admissions and improved patient experience Community COPD clinics Other community services Secondary care referral Education & training for healthcare professionals Medication optimisation Self referral

11. Reflection • Timescale • Commitment • Logistical issues but….. • Collaborative working rewarding • Promising early results

12. April – Sept 2010 • 95 patients accepted for admission avoidance • 67 patients accepted for ESD/AD • 99 patients accepted for PR • 92 patients have undergone oxygen assessments • 54 prescriptions unchanged • 30 prescriptions altered • 8 prescriptions withdrawn

13. Acknowledgements BANES CSHCS RUH Bath Dr Gerrit van Rensburg Dr Andrew Alexander Dr Noeleen Foley Dr Adam Malin Dr Vidan Masani Judith Rollason Mark Grover Clare O’Farrell Nicky Ashton • Claire Bullard • Fi Cook • Stella Doble • Louisa Ireson • Jill Peel • Raymond Owens • Carol Lacey