One nurse, many practices

Monday, October 28, 2019

How a “travelling” Respiratory Nurse Specialist could save money and improve outcomes -A conversation with Sarah Anderson and Melissa Canavan of Respiratory Care Solutions.

Respiratory Futures has recently visited the Respiratory Show in Birmingham, and bumped into our old acquaintance Respiratory Care Solutions (RCS). Sarah and Melissa where there both as exhibitors and speakers. We took this chance to have a little chat about their work. 

It has been nearly a year since we last spoke. What has RCS been doing since January?

Well this year has gone so fast! I am still working with the 12 GP practices to standardise the respiratory care and the lead nurse for the PCN. Sarah has now left the NHS to focus on the social enterprise and her aesthetics business.

We saw you are also presenting a poster at the conference, it mentioned that Respiratory Nurse Specialists can help GPs reduce costs. Can you tell us how? 

Different practices have different issues. One had a problem with incorrect diagnosis of COPD so we have stopped inhaled therapy on a number of patients, for example. In others we have reduced costs by ensuring patients are on the correct inhaled therapy and stepping down therapy where indicated. Collectively in 18 months we had reduced our respiratory prescribing costs by £220,252 that can be reinvested back into the NHS. 

We completed a training needs analysis with the nurses in the practices, then worked on what was needed in each practice, like update sessions on asthma, COPD or spirometry for example. Nurses have also been supported to complete respiratory diplomas and spirometry courses.  We have worked together on joint clinics, virtual reviews and education sessions.

But we also helped them to standardise care. Health care professionals have different levels of training and different time allocated for completing reviews; now they are given the same amount of time across sites.  I have also worked with the local schools and community pharmacy to standardise messages on asthma.  

That sounds brilliant, but I am sure there is more. What are the other benefits of having a RNS working with several practices?

The respiratory service has created capacity in a struggling locality that has a severe nursing crisis by holding lots of solo clinics for high risk patients.

We have focused our reviews on the higher risk patients and those on the medicines management lists, rather than just QOF (Quality and Outcomes Framework) reviews, to get more value from the service. The reviews have helped practices achieve QOF and LES (Local Enhanced Service) targets but have also helped create less demand for GP appointments with better management. 

As well as the financial savings, freeing up GP appointments, there has been a positive impact on the working relationship within the locality. The relationships have flourished over the 18 months. Working across the 12 surgeries has enabled the Respiratory Nurse Specialist to get to know lots of different people and then connect them with others who are going through same difficulties or wanting to learn new skills etc.  A nurse forum and HCA forum has been set up to learn and share from each other. This is truly invaluable, as they now feel safe to open up about their issues and we all try to help and support each other.  Staff highly rate the education sessions, and have found them valuable. It was great to see they have made changes in the way they work, following the sessions. Nurses have been supported to complete respiratory diplomas and feel more confident to manage patients.

So even having just a single Nurse Specialist visiting regularly can add a lot of value to the GP practices in your area. Did you measure any other outcome so far, on top of the financial savings?

When we started the project, we collected baseline data to monitor change in a number of areas,  but we found it difficult to get follow up data except for respiratory prescribing costs. Unfortunately we were also unable to obtain data to see how we compared to other localities to see how much savings they have made without the help of a RNS.

So, I would say it made a big difference, we just don’t know if it could have been even bigger!

RF: You have been pioneers of this model, do you know if there are other social enterprises like yours being established around the UK? Any tips you want to offer to someone wanting to walk in your shoes?

We are not aware of any other social enterprises doing the same as us but if people were thinking about it we’d say be brave and go for it! You just have to have patience and believe in yourself even in the hard times. It’s important to network with like-minded people that will motivate you and people you can ask for advice and support. We have met so many different people that have helped us along the way and we could not have done it without their support!

As always, it was great talking to you, best of luck for your session!