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

Bath & North East Somerset (BANES) PCT

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

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

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

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

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

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

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

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

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

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PR 92 patients have undergone oxygen assessments 54 prescriptions unchanged 30 prescriptions altered 8 prescriptions withdrawn

Acknowledgements BANES CSHCS RUH Bath Claire Bullard Fi Cook Stella Doble Louisa Ireson Jill Peel Raymond Owens Carol Lacey 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