COPD in KCWCC now and future

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COPD in KCWCC now and future

• Dr Sarah Elkin
• Consultant Respiratory Physician
• St Marys Hospital

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Primary care data (Kings fund)

• London prevalence low(probably not capturing)
• Indicators on flu jab and inhaler technique
  increasing variation within/between PCTs
• Indicators on spirometry marked variation/
  considerable scope for
  improvement
• Increase in disease specific therapy

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Outline services we have now

• St Marys
• One stop clinic
• Open access spirometry
• General clinics x 3
• Physio led F/U clinic
• Pulmonary rehab

3 consultants 0.4 senior physiotherapists 3 lung
function techs
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Chelsea and Westminster

• One stop clinic
• General clinics x 3
• Spirometry

Consultants 3 Lung function techs 1 1 respiratory
nurse specialist
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Royal Brompton Hospital

• One stop clinic/F/u clinic
• Spirometry
• Pulmonary rehabilitation
• Severe COPD clinic

Physio 1 session Consultant 2 sessions One FT
clinical academic COPD research
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Westminster PCT

• COPD steering group
• ICP in progress
• Physio clinical specialist COPD- lead on
  pulmonary rehabilitation
• Rapid response team of 12
• WRS
• Community matrons
• Nurse specialist COPD
• NO GIPSI

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Kensington and Chelsea PCT

• Steering group on COPD
• Pharmacy guidelines
• Exploring funding for nurse specialist
• GPSI
• Rehabilitation team
• Community matrons
• Recent funding acquired for CNS

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At present.

• No unified approach to service development
• Current lack of coordination of services
• Communication poor between health care
  professionals/groups
• Available up to date data are sparse across the
  PCTs
• Unclear future disease burden
• Research fragmented

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Philosophy (adapted from brent model)
COPD specialist nurses
empowered GPs
Case management
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Outpatients/secondary care

• Easy access One-stop COPD clinics for new/problem
  patients
• Severe COPD clinics/LTOT assessments
• Ease of access to consultant opinion (less than 1
  week for routine appointment, next/same day for
  urgent cases)
• Email/virtual clinic (24 hr response time)
• Open access same day reported CXR service with
  fast-track for abnormal films
• Less severe patients managed by own GP
• Severe chronic care patients looked after at home
  by nurse specialist team ease of access by
  patient

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Primary Care

• Run locality based open access spirometry clinics
  
• Smoking cessation
• Increase basic standard of respiratory care
  amongst GPs
• Improve education of practice nurses
• GPs work with respiratory nurses/Physios and
  community matrons with case management to prevent
  admission
• Locality based pulmonary rehabilitation

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Patients

• Expert patient scheme
• Increase awareness/education of public with
  regard to respiratory illness
• Patient education in One-Stop clinic
• Spirometry screening in targeted pharmacies along
  and smoking cessation

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ICP should enable

• Reduce inequalities in access and variation in
  quality of care
• Delivery of high quality seamless care for
  chronic respiratory disorders from disease
  prevention to intensive care and palliation
• Removal of boundaries between primary and
  secondary care and dependence on secondary care
• Enable more COPD to be managed in the community

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A. Find out what is happening nowData is needed

• Survey of patients attending AEs
• Admissions to the 3 hospitals
• Referrals to pulmonary rehab at St Marys and
  Brompton (referrals and process)
• Referrals to rapid response
• Referrals to WRS (respiratory)
• Referrals to KC rehab (respiratory)
• One stop at CW and Marys and Brompton( referrals
  and process)
• Referrals to Spirometry
• Referrals for LTOT assessments and ambulatory

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B. Draw up unified referral guidelines for each
modality

• Including
• communication details
• -referral criteria
• -users of services
• -follow up