What motivated you to start up Leeds Respiratory Network?
Melissa: I work as a practice nurse in Leeds and I have always been interested in respiratory. But as a practice nurse, it can be quite lonely – I’m the only one in my practice, for example. There was no one really to ask for advice or ideas, to check if you were doing things right.
So in 2013 after attending the Primary Care Respiratory Society [PCRS] leaders workshop, I had this idea to set up a network of likeminded people to support practice nurses in their respiratory work – there wasn’t anything like this in Leeds. I asked Sarah [Anderson], a friend and a fellow practice nurse with an interest in respiratory, to get involved and we just took it from there.
So what sort of support does it offer to practice nurses?
Melissa: As a practice nurse, the list of things you have to deal with is endless: baby injections, travel injections, dressings, blood, ECGs, diabetes, etc. There can be a bit of information overload. So one of the key reasons we set up the network was to help nurses stay up to date with all the relevant information that they need to know.
We’ve got good communications with secondary care consultants – they are keen to work with me and Melissa. With any new developments, they give us the information so we can disseminate it among practice nurses in Leeds.
On a very practical level, we send out an email nearly every week where we share any new information we get with the network – guidance, resources, things like that. It’s just a really easy way for people to keep in touch with new developments or fill any gaps in their knowledge.
Through our emails we’re trying to encourage nurses to think outside the box. If they see changes that can be made, we encourage them to be brave and start making them – don't wait to be told. We’re trying to inspire and motivate the practice nurses in Leeds to become leaders.
Are you only working with practice nurses?
Melissa: That’s the main audience for our emailing list but the actual network spreads much wider than that: we’ve also got GPs, community matrons, CCG pharmacists, school nurses, prison nurses, secondary care nurses and respiratory consultants. And because of Twitter, we’ve got contacts right across the country and even internationally.
It means we’ve got a really wide range of people we can turn to for information. We often schedule evening meetings with or email respiratory consultants to find out what’s new and what that means for practice nurses. Recently, for example, we did a leadership programme within the CCGs and focused it on the review of asthma deaths. So as part of that project, because of our network, we were easily able to meet with the respiratory and A&E consultants to see what was happening and how we could improve things.
What made you focus on respiratory?
Melissa: I just love respiratory. I’m really interested in it but I was also shocked when I looked at the atlas of variation and saw that that Leeds was one of the worst performing areas in the country in terms of respiratory care. When I looked at the INHALE [Interactive Health Atlas for Lung conditions in England] report, I saw that our area was significantly worse for a lot of things: COPD admissions, emergency admissions, recording FEV1s.
So it makes you want to do something about it. Because here in primary care, this is where the majority of patients are seen – we’ve got all these people, but not necessarily enough healthcare practitioners with the right training to treat them properly. But if we can learn to manage patients better in primary care, there won’t be as much demand on hospitals, there won’t be as many unplanned admissions. In the long term, these are the sorts the things we’d like to help change.
Do you think the network can really reduce this variance in your area?
Melissa: We set up the network to try and improve things through education. We felt that if we improved the education of the nurses – particularly in relation to respiratory reviews – hopefully in the longer term that would have better outcomes for patients in Leeds. So that’s why we originally started with the educational meetings in the evening and then we set up the emailing list.
Do you think this is filtering down to impact patient care already?
Melissa: Yes I think so. We get emails from nurses in the network asking questions and we try and find out the answers and send it out to the group as a whole so they’re all learning from each other. Some people might want to ask a question but they daren’t, or someone else has asked it, so we just share the answers out to everyone. People are saying to us that they’ve learned a lot.
We’re trying to inspire and motivate the practice nurses in Leeds to become leaders – to think outside the box
We’ve also got the CCG pharmacists and the lead nurses from the CCGs on our network, so we’re sending out all the messages and information we get to them as well – we think it is influencing what CCGs prioritise.
For example, one of the CCGs is now focussing on their medicines management for respiratory, stepping down high dose steroids in asthma and COPD. They have also just employed an asthma specialist now – we hope we’ve been a positive influence in decisions like that.
You’ve been going more than 15 months – what do you think are your key achievements?
Melissa: Organising the event in October 2014 with PCRS, our joint conference day. I think that was our biggest achievement because we wanted to do it and we managed to pull it off exactly year after we first started. Because of the speakers that we had like Professor Mike Morgan [Respiratory National Clinical Director] and others, we just feel like it was a real achievement to get people like that to come along.
I also think that it was a turning point as well for the people who attended the event, especially the practice nurses; I think they understood at that point why we set up the network and why it is important. I feel like they really got on board with us after that.
You’ve been very proactive in using social media – what sort of difference has that made?
Melissa: We’ve got about 80 people we contact directly on our emailing list, but our social media network is much broader than that – we’ve got a lot of contacts on Facebook and on Twitter we’ve got more than 800 followers.
In particular I think it’s helped us network nationally. We’ve met people through Twitter that we wouldn’t have met otherwise – we would never have been aware of them. They’re very knowledgeable and they’ve helped us, we can get advice from them and they support us as well.
What advice would you give to anyone else thinking of setting up their own network?
Melissa: Just do it. It’s easy. It doesn’t cost anything – well it hasn’t cost us anything. It doesn’t take up a lot of time. And you get a lot of satisfaction – especially when the nurses tell us we’re making a difference and they can trust us with their queries.
You’re working in a relatively new health landscape – has your role change since the introduction of CCGs?
Melissa: My role as a practice nurse has not changed since the introduction of CCGs. But it’s because of the way that CCGs work that we had the idea of setting up Leeds Respiratory Network and now we are developing further to set up a social enterprise. We’ve realised that there is a gap in the market.
When I first heard about the setting up of CCGs, I thought it could be a bad thing, fragmenting care due to opening up to private providers. But now we can actually use this to our advantage.
I’ve been attending the CCG meetings for quite a while now. It’s good to hear what’s going on, what the plans are and have a little bit of a voice. And that influence could be growing as commissioners are starting to become more aware of our network. For example, I’ve got a meeting arranged next week with a commissioning GP to discuss end-of-life care for respiratory patients in Leeds.
What are your plans going forward?
Melissa: We would like to evaluate the progress of our network formally. But this year we will be focusing on setting up our social enterprise. We’ve secured funding now from two grants so we’re just waiting for some legal advice on which structure to use before we formally establish it.
prevalence of COPD
The idea of the social enterprise will be to go to GP clinics and do their asthma and COPD reviews, basically because there’s a shortage of qualified practice nurses in these areas. You could say it’s going to be like a nursing agency but only providing respiratory care. All profits will go back into the business.
Who knows how far it could go? The idea to start with is to offer standard respiratory reviews to GP practices. But we might move on to offer cost-saving exercises – reducing the costs and improving the quality of your respiratory services – at a practice level or even at a CCG level.
And do you think Respiratory Futures can support you to achieve your goals?
Melissa: Yes definitely! Just having the support and backing of Respiratory Futures gives us more confidence to go knocking on the CCG doors with ideas of how we think respiratory services can be improved in Leeds. We learn so much about respiratory commissioning from professional workshops, these are another support mechanism to make us stronger and get our voice heard.
We would like to thank PCRS and Respiratory Futures for the support and guidance you give us!
Thanks very much. This all sounds really interesting – good luck and keep us updated!
Melissa: Thanks – we will do!