IMPACT (Bath) – bringing primary and secondary care COPD services closer together

1. IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist

2. Bath & North East Somerset PCT

3. Outline Commissioning COPD services – primary or secondary care led? Service description Reflection

4. Changing expectations of provision and service Patient centred Community provision Provider centred Continuity of care Episodic Fragmented Self management Paternalistic care Limited services End of life care, Pulmonary Rehab etc

5. COPD in BANES Aug ‘07 BANES Strategic Development Implementation Group formed July ’08 Commissioning recommendations produced Dec ’08 BANES intermediate services put out to tender May ’09 Bath & North East Somerset PCT Royal United Hospital, Bath awarded tender Dec ’09 IMPACT service start date

6. Outline Commissioning COPD services – primary or secondary care led? Service description Reflection

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

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

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

10. Outline Commissioning/tendering process COPD services – primary or secondary care led? Service description Reflection

11. 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

12. 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

13. COPD patients often have multiple admissions Royal United Hospital, Bath data (2006/7)

14. 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

15. Integrated working - an improved experience for patients GPs Palliative care Locality teams Smoking cessation clinics Community hospitals Voluntary organisations I M PACT I M PACT Secondary care Secondary care

16. 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

17. Outline Commissioning COPD services – primary or secondary care led? Service description Reflection

18. Reflection • Impact of IMPACT • Challenges

19. April – Oct 2010 • 110 patients accepted for admission avoidance • 75 patients accepted for ESD • 121 patients accepted for PR • 121 patients have undergone oxygen assessments • 75 prescriptions unchanged • 38 prescriptions altered • 8 prescriptions withdrawn

20. Summary Commissioning COPD services – primary or secondary care led? Service description Reflection

21. Thank you for listening Contact: Claire.Bullard@banes-pct.nhs.uk Tel: 07540 674724