A truly integrated respiratory service: the first steps

Following the launch of our recent National COPD Audit secondary care outcomes report, Arvind Rajasekaran, clinical lead at Future Hospital development site Sandwell and West Birmingham Hospitals NHS Trust, outlines how collaborative working with general practice colleagues and local information sharing is saving money, and improving care and outcomes for patients.

Collaborative, multidisciplinary working

The Respiratory in Community Care Extension (RiCE) project at Sandwell and West Birmingham Hospitals NHS Trust is one of the Future Hospital Programme’s development sites, working with multidisciplinary teams including patients, carers and our partners in social care.

Using the recommendations from the Future Hospital Commission report, our trust’s ambition is to be recognised as the best integrated care organisation in the NHS. The initiatives from our ‘Right Care Right Here’ programme have supported substantial growth in respiratory services in the community over the past decade. A review of respiratory care in our population found increased prevalence of chronic obstructive pulmonary disease (COPD) and other long-term conditions, as well as variations in spending and outcomes.

The key aim of our integrated respiratory project is to facilitate collaborative working among teams involved in caring for patients with COPD and other long term respiratory diseases. We are working to dissolve the barriers that currently exist across services, as a local exemplar of how equitable and high value care can be provided to all patients.

We are focused on improving early diagnosis and detection of respiratory conditions in the community. Through collaborative working among specialists and generalists, and by increasing the expertise and support in the community, we hope to manage a larger proportion of respiratory patients and emergency admissions, and reduce hospital readmissions.

Continuity of care for patients

It is no secret that integration of care with joined up services is particularly effective for patients with long-term conditions who require specialist advice and support but do not necessarily require hospital admission.

One intervention we are piloting is embedding specialist support in primary care through co-located clinics. Removing the traditional boundaries between primary and secondary care, and seeking opportunities to engage patients (and, where appropriate, carers) allowed us to deliver integrated care pathways: a key aim of the project. From the patients seen, we managed to avoid a series of outpatient appointments, an emergency admission and an ultrasound.

From the patients seen, we managed to avoid a series of outpatient appointments, an emergency admission and an ultrasound.

Arvind Rajasekaran, clinical lead at Sandwell and West Birmingham Hospitals NHS Trust

Integrated respiratory services in Birmingham

We cross-referenced patients registered with a primary care practice with frequent attendees at the trust (accident and emergency, emergency medicine inpatients, or outpatient clinics). From this the GP identified patients who could attend their local surgery for a joint consultation with the GP and the specialist in the same room.

We chose to measure our success against cost savings, shared knowledge and patient outcomes – so far the early results are encouraging. Medicine was rationalised, there was a sharing of expertise, and there were overall cost savings with a recurring saving on drugs. The costs for clinicians’ time was not deducted from this total but would not have exceeded the saving.

Encouraged by this early success we are going to use PDSA (plan, do, study, act) cycles to refine, spread and gather more data on the process to ensure we have the most robust model to deliver the best care possible – watch this space!

National COPD Audit Programme

Follow @NatCOPDAudit on Twitter to find out more about our work on national audits, COPD and quality improvement, and join the conversation using #COPDwhocares. You can also download a copy of the National COPD secondary care outcomes report. For further information contact the project team: copd@rcplondon.ac.uk.

Future Hospital Programme

Follow @RCPLondon and join the conversation on integrated care using #FutureHospital. You can also find out about our Future Hospital Programme and the work of our development sites by getting in touch with the team: futurehospital@rcplondon.ac.uk.