1. Progress Report June 2010

2.  Introduction  Background  Baseline position  Delivery  Improvements

3. Objective: To improve the care of patients with COPD in Somerset

4.  Commissioners – WH.C (GP/Managers)  Community Service  External Facilitator  Pharmaceutical Companies:  AstraZeneca UK Limited  Boehringer Ingelheim Limited  GlaxoSmithKline UK Limited  Pfizer Limited

5. 2 nd Care Community COPD Service Primary Care Self Care Prevention

6.  Training Needs Analysis  Work with pharmaceutical industry using audit tools – POINTS and OSKIS  POINTS – is one of the tools and services provided by Allen and Hanburys’ Respiratory Care Team (RCT). The RCT provides a non promotional service, committed to working with healthcare professionals to optimise the management of patients with COPD.  OSKIS – is one of the tools provided by the Clinical Services Team at AstraZeneca UK Limited, this is a non-promotional service which specifically work with NHS organisations and healthcare providers to improve the care and management of patients.

7.  The Patient Outcomes and Information Service (POINTS) is an analysis and audit tool that allows focus on improving patient outcomes.  Practices receive a “baseline report” which contains an analysis of the practices total COPD population.  “Follow Up” reports are run at agreed time periods to track change and progress during the audit period. Summary:  Evaluation of your structured management of COPD as recommended by NICE  Evaluation of specific interventions  Identifies areas for improvement

8. “POINTS” REPORT EXAMPLE PAGE *Short black line shows position at baseline Longer line shows position at time of follow up report HCM/MDM/08/39407/1 Mar 2009

9.  This is a case finding toolkit  It takes a snapshot of patients on the GPMS and includes all patients with a respiratory READ code and those on medication indicative of a respiratory condition.  Patient groups can then be searched for eg all COPD patients who have had exacerbations in last 12 months, or patients with poor control.  These patients can then be invited in to clinic for review.  It will provide practices with a baseline position against NICE guidelines and follow up reports to track progress  The PBC/PCT can have collated reports identifying the baseline and follow up position for practices in the project.

10.  How do you diagnose COPD? Some variation; upward of five different tests  Follow up case  frequency and type of follow-up case  different levels of clinical supervision  CPD in COPD  Short course  Degree or diploma (67% of nurses treating COPD)  Wide diversity in training raised questions of consistency and quality.

11. From the OSKIS audits:  A higher than expected number of patients are on both Asthma and COPD registers.  Patients are not consistently being READ coded for mild, moderate or severe COPD.  There are a number of patients in some practices who are on a respiratory register but are not having any treatment.  There are a number of patients across Somerset who are not being treated according to the NICE guidelines for their COPD.

12.  Structured programme  Measuring outcomes  Mentoring support  Self-sustaining

13.  Level 0 – COPD awareness for practice staff  Level 1 – Introduction to COPD for new practice nurses  Level 2 – Diploma course for practice nurses  Level 3 – Post-diploma/CPD for COPD lead practice nurses

14.  Level 0  Level 1 - 10 practice nurses  Level 2 - 15 practice nurses  Level 3 - 13 practice nurses

15. Level 1  Competency self assessment from nurses at the beginning and end of mentorship  Feedback on modules  Sign up for diploma 50% + Level 2  Recording of exacerbations  Recording of FeV1  COPD reviews  Recording or MRC dyspnoea (breathlessness)  Stratification of mild moderate and severe patients as per NICE  Use of medication by mild moderate and severe COPD code as per NICE  Referral to COPD service March 10, Sept 10 and March 11  COPD admissions from HES data Level 3  All the above by whole practice  Individual projects with outcome measures set around the clinical strategy to be measured after 12 months and fed back to Wyvern. (Need a baseline audit to identify the specific area for the project)

16.  14 clinic locations  1898 referrals (1531 primary 367 secondary care)  67 out of 75 practices referred to service  PR: 12 programmes to date, 483 invited, 136 completed (28%)  Patient survey to 900 patients, 30% response rate, analysis completed  24/7 help line

19.  Raised awareness of COPD  Improved management of patients in primary care  Increased use of the community service. 1628 referrals in last two years (last six months average 56 referrals/month; previous six months 43 referrals/month)  Better information on COPD for patients  Reduction in emergency admissions. Overall emergency admissions for Somerset patients increased by 1.8% in 2009/10 compared to 2008/09

20.  Evaluation  New programme of training  Asthma

21. Support from the following pharmaceutical companies:  AstraZeneca UK Limited  Boehringer Ingelheim Limited  GlaxoSmithKline UK Limited  Pfizer Limited The WH.C COPD Education Steering Group Members

22.  St James Medical Centre, Taunton  Lister House, Wiveliscombe  Tawstock Medical Centre, Chard  Hendford Lodge Medical Centre, Yeovil  Park Medical Practice, Shepton Mallet  Millbrook, Castle Cary  Wincanton Health Centre  Brent House Surgery, Bridgwater  Preston Grove, Yeovil  Luson Surgery, Wellington

23.  Cannington Health Centre  Taunton Rd Medical Centre  College Way Surgery  Highbridge Medical Centre  Redgate Medical Centre  Irnham Lodge Surgery  New East Quay Medical Centre  Axbridge Medical Practice  Milborne Port Surgery  Stoke-Sub-Hamdon Medical Centre  Springmead Surgery ** Audit provided by POINTS – Allen and Hanburys Nurse mentorship provided by – Ashfield in2Focus through AstraZeneca

24. POINTS  Taunton Rd  Cheddar  Frome  Langport  Cannington  West Coker  North Street  Wellington  Williton  College Way OSKIS  St James MC – Taunton  Lister House - Wiveliscombe  Tawstock MC – Chard  Hendford Lodge – Yeovil  Park MP – Shepton Mallet  Millbrook – Castle Cary  Wincanton HC  Brent House – Bridgewater  Preston Grove – Yeovil  Luson Surgery - Wellington