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Intermediate COPD services in Bath – the IMPACT model

A service description by Dr Jay Suntharalingam

Thursday, November 22, 2018

Dr Jay Suntharalingam is accredited in both Respiratory and General Medicine. He is the Royal United Hospitals Bath clinical lead for COPD and is responsible for developing COPD services, including the BANES community COPD team (IMPACT), run by Virgin Health.

 

He also runs a regional Pulmonary Hypertension service in conjunction with the Royal Free Hospital, London, helping to deliver specialist Pulmonary Hypertension care to patients across the South West.

 

Here Dr Suntharalingam tells us more about how IMPACT operates in Bath.

Since 2010 we have offered a community-based multidisciplinary service that both in-reaches into secondary care and links with other healthcare professionals in the community to deliver a patient-centred service for local COPD patients.  The service is called “IMPACT” – IMProving Access to COPD Therapies – reflecting our aim of delivering high quality personalised care closer to home.

The IMPACT programme shows how a small multidisciplinary team collaborating actively with primary and secondary healthcare, social care, and rehabilitation services, can have a rapid and positive influence on the management of COPD, both through direct patient interaction and through up-skilling the wider healthcare community.
Dr Jay Suntharalingam

The service is provided by physiotherapists, nurses and rehabilitation assistants hosted by an independent organisation (Virgin Health).  Referrals are accepted from primary care, secondary care, and patients already known to the team.  

Support from secondary care (Royal United Hospital (RUH)) allows patients rapid access to Consultant Respiratory physician input through a 9-5 on-call service and through virtual MDT ward rounds, giving access to appropriate and timely interventions while keeping the convenience and benefits of a community-based service. 

Since 2010 the service has had contact with >1700 individual patients.  The service enjoys high patient satisfaction.   The service has also been recognised by the British Thoracic Society (BTS) in their ‘Excellence and Innovation’ category at the 2014 BTS Summer meeting.

Since 2013 the team has been expanded to include a unique and innovative GPST placement. This post provides a natural interface linking primary and secondary care.  This includes in-reach acute assessment, consultant-supervised clinic and ambulatory care work shared with community experience - domiciliary visits, community clinics and admission avoidance.  By helping to train the GPs of the future the post also contributes towards our aim of bringing primary and secondary care closer together – as a result the post has recently been championed by the GMC as a good example of a ‘community-facing’ training post.

Since 2016 the remit of the IMPACT service has been widened to include patients with bronchiectasis.  Given the more complex nature of bronchiectasis the service is run predominantly by the secondary care team, using a ‘hub and spoke’ model.  The IMPACT team provide key nursing and physiotherapy support for bronchiectatic patients in the community and, through the use of community-delivered intravenous antibiotics, help reduce unnecessary admissions to hospital.

The range of services provided by IMPACT are summarised below:

  • Early Supported Discharge – the team ‘in-reach’ into secondary care every weekday morning to identify patients suitable for early discharge.  Once home, the team provide support for discharged patients six days a week
  • Admission Avoidance – patients known to the service who develop an exacerbation are typically seen <24 hours after a referral is received, helping to reduce unnecessary admissions to hospital
  • Pulmonary Rehabilitation – the team provide rotating programmes at three community locations throughout the year
  • Community/domiciliary-based COPD clinics - offering assessment, management and patient/carer education
  • Community/domiciliary-based home oxygen service – new and follow up assessments are provided in patients’ own homes.  Since the service was started in 2010 monthly spend on domiciliary oxygen has fallen from ~£35K to ~£17K/month, releasing significant savings for the CCG
  • Audit – the IMPACT team have supported the RUH’s involvement in the national COPD audit, allowing the RUH to achieve the Best Practice Tariff (BPT) in all four quarters since February 2017
  • Education– regular sessions delivered to practices and community nursing teams
    By helping to train the GPs of the future the [GPST] post also contributes towards our aim of bringing primary and secondary care closer together – as a result the post has recently been championed by the GMC as a good example of a ‘community-facing’ training post.
    Dr Jay Suntharalingam

The IMPACT programme shows how a small multidisciplinary team collaborating actively with primary and secondary healthcare, social care, and rehabilitation services, can have a rapid and positive influence on the management of COPD, both through direct patient interaction and through up-skilling the wider healthcare community.