How Strategic Clinical Networks (SCN) can drive and shape improvements in respiratory care – The Greater Manchester case

Friday, March 20, 2020

SCNs’ connect commissioners, providers, professionals, and patients and the public, and provide clinical leadership and advice to improve health and care services in their region. The Greater Manchester and Eastern Cheshire Strategic Clinical Network (GMEC) is part of 12 Strategic Clinical Networks across England.


(in the picture, the GM Respiratory SCN core team.  Left to right, Dr Peter Elton (Clinical Director), Dr Jennifer Hoyle (Clinical Lead), Gareth Lord (Programme Manager) and Dr Murugesan Raja (Primary Care Advisor)

The impact of respiratory disease on health and health care services has been on the Greater Manchester radar for some time.

Prior to the publication of the NHS Long Term Plan, the Greater Manchester Health and Social Care Partnership (GM HSCP) gave a mandate for the GM Strategic Clinical Network (SCN) to expand its remit to cover respiratory disease. The initial objectives given to the SCN were to:

  • Review the current challenges of respiratory disease.
  • Review GM initiatives against those challenges.
  • To define what more could be done in addition to what was being done (by exploring gaps and opportunities).

Essentially, the Network was tasked with developing a Greater Manchester-level programme to tackle the challenges of respiratory disease. This began with the establishment of a Respiratory Strategic Clinical Network (within the SCN).

The Respiratory Improvement Framework

The formation of the Respiratory SCN began with the allocation of a programme manager (lucky me!), and the appointment of two strategic clinical leads; a secondary care lead - Dr Jennifer Hoyle (Consultant Physician at Pennine Acute NHS Trust), and a Primary Care Advisor - Dr Murugesan Raja (GP, Manchester CCG).

As a Respiratory SCN hadn’t existed as such before, we needed contacts, evidence and system leadership to drive the work forward. So, following some initial planning, we embarked on a huge scoping exercise. We started by gathering intelligence from national data sets, audits, and various publications, which we used to prepare detailed reports on what the local challenges to respiratory patients and medicine were.

We then shared these findings with the respiratory physicians in the area as well as with other groups and organisations dealing with respiratory medicine and patients, and discussed with them what we found, what we were trying to achieve and ways we could do so.

This big networking and discussion exercise allowed us to connect with stakeholders from different disciplines and localities that could come together to help drive the work. In June 2018, we formed a Respiratory Steering Group, a group accountable to the Executive Lead for Quality in the GM Health and Social Care Partnership, to identify local priorities based on their potential impact, review what was already being done about them and propose new initiatives if they were not currently been addressed. The final task given to the group was to recommend ways to co-ordinate all these respiratory initiatives more effectively.

The GM Respiratory Steering Group set four priorities:

  • Improving early detection and diagnosis.
  • Helping to prevent influenza and pneumonia.
  • Helping to reduce tobacco addiction.
  • Preventing/reducing avoidable hospital presentations.

The Group then set up a number of smaller task and finish groups to identify existing initiatives, and develop new ones, that could address its vision and priorities.

All proposals were put forward for consultation, primarily through a large event attended by more than 100 people from across the GM area. It was by combining new and existing initiatives, that we were able to form the GM Respiratory Improvement Framework, which provides the structure and strategy to address our respiratory priorities.

To support some of the proposals being put forward as part of the Improvement Framework, the SCN has since led on several pieces of work.  This includes preparatory work for the NHS Long Term Plan, such as; scoping the GM provision of quality assured spirometry, proposing clinically recommended models for future delivery (for QAS), and providing the commissioners with options moving forward.  In addition, we’ve scoped and compared Pulmonary Rehabilitation and local breathlessness services, identified local strengths and opportunities for improvement, and provided GM commissioners with a set of options that can be further supported ahead of targeted investment.  We’ve also been co-ordinating and supporting localities with targeted investment proposals.

Other new initiatives were innovative pilots such as bringing spirometry into heart failure clinics, education sessions for those newly diagnosed with COPD, and opportunistic flu vaccinations in respiratory outpatient clinics.

At the same time, we’ve helped to raise the profile of the GM CURE project as an area of best practice across the North West, and we’ve been working with our cancer team to follow up patients screened from the lung health checks.

We’ve also been co-ordinating and supporting localities with targeted investment proposals.

And there is still plenty more to do…

Over the next year, we will be shaping our inhaler strategy and initiatives to ensure effective inhaler technique is provided in the community, environmentally friendly inhalers are offered, and medications are regularly reviewed. We will be exploring menu-based life style education concepts for multi morbidity, and we will be unpicking the burden of pneumonia.

If I was to summarise, I suppose fundamentally, we’ve been able to provide structure and strategy to improving respiratory care in GM.  It’s not been easy, it’s often been like herding cats, but by having a regional approach we have been able to address unwarranted local variation, integrate large scale projects and instigate conversation and action across borders that perhaps would not have happened otherwise.