In September 2016 I left my role in primary care for a 12 month contract as Respiratory Nurse Specialist at Leeds Teaching Hospitals Trust. The aim was to secure a contract for our social enterprise, Respiratory Care Solutions (RCS), before the year was up.
Initially RCS organised educational events and then, over time, my work as a practice nurse helped me see the challenges of having a shortage of nurses and limited time for reviews. This led us to set up the business service side of the social enterprise where we could help practices undertake respiratory reviews for asthma, COPD and so on.
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We have just secured a contract working with a collaboration of 8 GP practices in Leeds which has a footprint of about 40,000. The contacts we are working with are helping us to develop the role as we go and we intend to standardise clinical templates, management and medicines optimisation plans, and in the process help with CCG initiatives.
We will be collecting baseline data from the CCG and working with Optimum Patient Care, another social enterprise that uses anonymised data for research. In a year’s time we’ll run reports to measure progress. Ultimately, we want to reduce variation across all 8 practises in order to improve respiratory conditions.
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We are fortunate to have gained different perspectives across primary and secondary care since September 2016. Work is becoming more integrated in Leeds where we have a COPD consultant and a community care team working in parallel. However, there is scope to do more with primary care we are aiming to increase its links to secondary care now that I have established my role.
If we could see one single change it would be to introduce diagnostic hubs in the community, specialised centres for GPs and Nurse Practitioners to refer into, to improve diagnosis and outcomes.
The hubs will offer ARTP quality-assured diagnostic spirometry and assessments by HCPs with a specialist respiratory interest, able to form a solid diagnosis. This would reduce primary care workloads and ensure correct diagnosis and treatment from the outset.
We’d also like more patients receiving appropriate treatment – i.e. there’s more work to do on inhaled therapy; we need to diagnose and educate people earlier and more consistently.
We are results-driven, trying new approaches to increase positive results. I am lucky to have free rein so I’m going to do just that! I want to change group consultations for COPD where it’s not a simple case of replicating what’s being done in diabetes. With COPD we have to educate earlier, not just when patients are very ill and in pulmonary rehabilitation. We want to try different consultation styles earlier on - in COPD it’s not positive to share everyone’s results to FEV1 (we’re moving away from FEV1 to symptoms anyway). Group sessions are fine where there’s consistent information but we must still offer individual, shorter sessions about exacerbations. You simply can’t do personalised care in a group.
Checking inhaler technique is also paramount; research shows that some HCPs don’t demonstrate correct technique so we can’t expect patients to learn correctly from each other.
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Before we secured this contract we received several requests from across the country, (often via LinkedIn) to do teaching or help with asthma initiatives. But we stuck to our guns because we wanted to stay in Leeds and focus on creating a franchise model that could be replicated across the country later on. It was important to fulfil this ambition first, having the confidence to turn other requests down in the short term to assist more people later on.
Networking and building connections have been crucial. For example, staying in touch with a Practice Manager we met at our own respiratory event last year, led to us securing this contract!
My advice to others with similar ambitions is, if you want to make changes and are passionate about an idea then be brave and go for it!
For me, working with Sarah was key to this project’s success. We have a unique relationship with very different, but complementary, skills. I’m the networker who likes encouraging people to do things out of their comfort zone, and Sarah is the cautious realist who brings me back down to earth. I tend to reel people in and she leads on the logistics.
We laugh a lot and sometimes pinch ourselves and ask “what are we doing, how did we get here? We’re just 2 nurses from Leeds!” Then we laugh some more and continue our mission!
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