1. How well have the recommendations for NRAD been implemented in Dumfries and Galloway?
Dr Fergus Donachie
GP lead for Respiratory Managed Clinical Network Dumfries and Galloway

2. Background Dumfries and Galloway has population 150,000
Served by one District General Hospital
35 GP practices

3. National Review of Asthma Deaths
Detailed review of all asthma deaths in one year
Showed care was poor
Suggested many of the deaths were potentially preventable
Made a series of recommendations to improve practice

4. How to implement this? Educational meeting
Letter to GPs and Practice nurses
Respiratory discharge bundle
Prescribing advisors

5. Survey of Practices Self reported Based on the NRAD recommendations
60% response rate

6. Everyone Had a practice asthma lead Actively chased non-attenders
Carried out an annual asthma review as per guidelines
Had a system to see acutely ill asthmatics quickly
Had the appropriate equipment and training to deal with acute asthma
Actively identified those at high risk (Lots of blue inhalers)
Used a standardised review template

7. Room for Improvement
85% of nurses doing reviews had a recognised asthma qualification
60% reviewed asthmatic patients within 48 hours of discharge
38% of patients had an asthma action plan

8. Further Interventions
Redesign and distribute simple asthma action plans to practices
Post discharge follow up by secondary care – phone or face to face
Offer to subsidise practice nurse training

9. Questions?