1. © Imperial College LondonPage 1 Consultants in Integrated respiratory care? Martyn R Partridge Professor of Respiratory Medicine NHLI at Charing Cross “Researching the delivery of respiratory healthcare”

2. © Imperial College LondonPage 2 Primary Care The Patient Secondary Care Tertiary Care The Traditional Model of Health care

3. © Imperial College LondonPage 3 Primary Care The Patient Secondary Care Tertiary Care The Traditional Model of Health care

4. © Imperial College LondonPage 4 Primary Care The Patient Secondary Care Tertiary Care Who provides care in each sector?

5. © Imperial College LondonPage 5 Traditional care Majored on diagnosis and the writing of prescriptions

6. © Imperial College LondonPage 6 Primary Care The Patient Secondary Care Tertiary Care Who provides care in each sector?

7. © Imperial College LondonPage 7 Traditional care Majored on patient care

8. © Imperial College LondonPage 8 Primary Care The Patient Secondary Care Tertiary Care Who provides each level of care?

9. © Imperial College LondonPage 9 Late 1970s /Early 1980s: In primary and secondary care

10. © Imperial College LondonPage 10 Published 2 nd April 1981

11. © Imperial College LondonPage 11 “With the marked decline of tuberculosis the tuberculosis health visitor has usually been transferred to other duties, but in a few cases she (!) continues as a respiratory health worker……….. 02 04 1981

12. © Imperial College LondonPage 12 “There would appear to be an important role for such a person in the management of respiratory prophylaxis and rehabilitation. The post might be filled by a nurse, occupational therapist etc “ 02 04 1981

13. © Imperial College LondonPage 13 Specific duties might include: a)Keeping a case register of persons with CRD b)Promoting respiratory health education c)Providing continuity of support d)Assisting in Domiciliary care e)….physical training.. 02 04 1981

14. © Imperial College LondonPage 14 The evolving model of healthcare The patient Nurses, MCPs, and HCAs GPs with a special clinical interest Resp Physicians Tertiary Care Acute medicine specialists

15. © Imperial College LondonPage 15 The evolving model of healthcare The patient Nurses, MCPs, and HCAs GPs with a special clinical interest Resp Physicians Tertiary Care Acute medicine specialists

16. © Imperial College LondonPage 16 Need to stop thinking about “Primary” and “Secondary” Care www.mkgeneral.nhs.uk witchdoctor.wordpress.com

17. © Imperial College LondonPage 17 Need to stop thinking about “Primary” and “Secondary”Care www.mkgeneral.nhs.uk witchdoctor.wordpress.com Ambulatory patients Patients needing hospital beds

18. © Imperial College LondonPage 18 Need to stop thinking about “Primary” and “Secondary” Care Ambulatory patients Patients needing hospital beds

19. © Imperial College LondonPage 19 Who cares for these ambulatory patients? Doctors Nurses Physios MCPs HCAs

20. © Imperial College LondonPage 20 But even within a team, and whether in hospital or the community the patient should have access to specialist care.

21. © Imperial College LondonPage 21

22. © Imperial College LondonPage 22

23. 1)Community Respiratory Assessment Unit 2)Respiratory Nursing Service 3)PCT funded, nurse run, hospital based oxygen assessment service 4) Pulmonary Rehabilitation programme 5) Consultant in Integrated Respiratory Care

24. © Imperial College LondonPage 24

25. 25% 47% 22% 40%

26. Consultant in Integrated Respiratory Care: Responsibilities (1) 1) promote integration of respiratory care between primary and secondary care 2) provide medical leadership for the current integrated services with a special reference to the community respiratory assessment unit (CRAU), the oxygen assessment service, pulmonary rehabilitation and medical support to the respiratory nursing team (including TB specialist nurses within the community). 3) support spirometry services in the community for practices which wished to provide their own service, rather than utilise CRAU and to ensure that standards of spirometry were adequate in terms of health and safety issues and interpretation of results 4)help in the selection of patients for pulmonary rehabilitation and to lead in the development of services for pulmonary rehabilitation in the community 5)provide medical leadership to the COPD admission avoidance and early discharge schemes, and to act as a link between the acute hospital COPD services and the nursing team.

27. © Imperial College LondonPage 27 Consultant in Integrated Respiratory Care: Responsibilities (2) 6) act as a learning resource and to provide continuing education for primary care physicians, practice and district nurses and community matrons 7) trial and evaluate outreach clinics (place of work teaching) and a community-based consultant clinic. 8) assess and manage patients with complex breathlessness in the community, liaising where appropriate with the cardiac services 9) work with others to promote better end of life care for those with severe lung disease 10) work with others to develop advanced respiratory support in the community for those needing home ventilation

28. © Imperial College LondonPage 28 Consultant in Integrated Respiratory Care: The Questions: 1.How do we evaluate such a post? 2.Can one person alone provide such a role? 3.Will there be an iceberg effect? 4.How do we extend service optimally beyond just being a COPD service? 5.If successful what training should future entrants to this sub-speciality have? 6.Is the Consultant appointment an irrelevance and is integration alone the priority?

29. © Imperial College LondonPage 29 Thank you Page no./ref