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North Region Respiratory Programme Delivery Pack

Tuesday, November 13, 2018

The North Region has highlighted three areas of variation for focus in the respiratory programme:

  • Flu and Pneumonia
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Adult Asthma

In the North Region Respiratory Programme Delivery Pack, shared with STPs and CCGs in Summer 2018, the North is recognising the importance of respiratory issues, noting that “over the last seven years, respiratory admissions have risen at over three times the rate of other conditions – 36.6% vs 11.1% and are significantly higher from December to March”1.

The North have good reason to focus their attention here and have identified respiratory disease as a regional collaborative priority due to higher than average incidences of respiratory admissions and disease in the region: "Respiratory accounts for the highest proportion (19.6%) of the total variation identified in non-elective admissions across the nine highest spending programme areas and may significantly impact on several key regional priority areas including the emergency care system, non-elective admissions and patients stranded in hospital."3

 

The North Region Respiratory Programme Delivery pack contains targeted interventions to address these health inequalities and improve outcomes for patients with respiratory disease.

"Respiratory accounts for the highest proportion (19.6%) of the total variation identified in non-elective admissions across the nine highest spending programme areas and may significantly impact on several key regional priority areas including the emergency care system, non-elective admissions and patients stranded in hospital."
NHS RightCare Intelligence

These interventions form three pillars:

  • primary care - early detection and prevention of deterioration,
  • responding to crises, and
  • secondary care. 

 

For each intervention an explanation of its importance as well as practical examples and tools are provided to support implementation.

The primary care interventions are:

  • Comprehensive practice breathlessness assessment algorithm.
  • Use of case finding/audit tools to identify potential cases and improve management of those with diagnosed disease.
  • Holistic review with personalised and agreed management plans in place before winter for all with asthma or COPD  including:
    • inhaler review,
    • medicines optimisation,
    • plan for exacerbations, and
    • frailty and signposting to support for deteriorating condition.
  • Refer all appropriate people with COPD to Pulmonary Rehabilitation (PR).
  • Flu and pneumococcus vaccination of target groups and ensure all eligible community and healthcare staff are vaccinated using every opportunity.
  • Review and treating tobacco dependency - smoking cessation.

 

The responding to crises interventions are:

  • Use of risk assessments for asthma, COPD, and community acquired pneumonia (CAP) and frailty to aid clinical decision making.
  • Multi-disciplinary and specialist respiratory care services including Rapid Response.
  • Breathlessness support services addressing physical and psychological aspects of breathlessness.
  • Treat tobacco dependency – smoking cessation.

 

The secondary care interventions are:

  • Ambulatory Emergency Care Services (AEC).
  • Adherence to the care bundles for asthma, COPD, and CAP and associated best practice tariffs.
  • Implementation of local Government Association Eight High Impact Actions & NHS Improvement Rapid Improvement Guide.
  • Treat tobacco dependency – smoking cessation.

 

You can read and download the full delivery pack here.

 

Additional resources:

Asthma

Asthma: diagnosis, monitoring and chronic asthma management NICE guideline [NG80] Published date: November 2017

BTS/SIGN guidelines on the management of asthma 2016

COPD

Chronic obstructive pulmonary disease in over 16s: diagnosis and management, NICE Clinical guideline [CG101] June 2010

Chronic Obstructive Pulmonary Disease (COPD) Pathway, NHS RightCare

New Models of Care for COPD

Royal College of Physicians. (2018) National COPD audit programme secondary care workstream 2015 – 2018 and good practice repository.

Frailty

Fit for Frailty Part 2: Developing, commissioning and managing services for people living with frailty in community settings

Recognising frailty in a more routine situation

Pneumonia

Pneumonia in adults: diagnosis and management, NICE Clinical guideline [CG191], 2014.

Tobacco Dependency

Smoking and tobacco - all NICE products on Smoking and tobacco. Includes any guidance, NICE Pathways and quality standards

British Thoracic Society Smoking Cessation Tools and Resources

British Thoracic Society Smoking Cessation Audit Report 2016

Vaccination

National flu immunisation programme plan

Influenza: the green book, chapter 19

Flu vaccination: increasing uptake NICE guideline Draft for consultation

Pneumococcal: the green book, chapter 25

Winter Planning & Resilience

British Lung Foundation “Out in the cold” December 2017

Quick Guide: Planning for increased seasonal demand in respiratory illness, NHS England and NHS Improvement, December 2017

 

References:

1 British Lung Foundation “Out in the cold” December 2017,

2 Quick Guide: Planning for increased seasonal demand in respiratory illness, NHS England and NHS Improvement, December 2017 

3 NHS RightCare Intelligence