1. Pulmonary Rehabilitation London Clinical Leads:Sam Prigmore & Maria Buxton

2. Objectives of London Respiratory Programme Pulmonary Rehabilitation Empower patients and their families living in London to better manage their COPD, including navigating services, coping with crisis and living with breathlessness Improve function and QOL, slow decline, increase independence and reduce dependence on healthcare during crisis by: - Providing timely and accessible PR across London - Enabling self – management

3. Working definition of Pulmonary Rehabilitation for London For people who are breathless due to chronic respiratory disease assessed as at MRC3 and above, or MRC2 plus a hospital admission, refer for a………… Cumulative programme of sessions offering individually tailored progressive (aerobic) exercise accompanied by education for behaviour change –One hour or more per session –Assessment at the beginning and end of the programme –Rolling and cohort programmes have their place –Flexible to accommodate different seasonal, language, cultural, scheduling and transport needs

4. ‘ NHS Choices – Pulmonary Rehabilitation http://www.nhs.uk/video/pages/medialibrary.aspx?Filter=&Id={A4D71829-05C5-4406-974E- 3EEE85E7A9EF}&Page=1&Tag=Treatments%2C+procedures&Title=NHS+VIDEOS+|+Pulmonary+rehabilitation&Uri=vide o%2F2009%2FNovember%2FPages%2FPulmonaryrehabilitation.aspx

5. What does this tell us about Pulmonary Rehabilitation? Its scope and value not widely known or understood Not just COPD – any chronic respiratory condition resulting in MRC 3-5 Combination of exercise (aerobic mostly) & education Minimum of 6 weeks (not including assessments) Exercise – individualised and progressive Breathing and coping strategies enabling patients to maximise potential Comprehensive education, self management, behaviour modification - MDT Peer support / carer involvement

6. Integration into respiratory services “ The quality standard for chronic obstructive pulmonary disease (COPD) requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole COPD care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with COPD. “ 8 People with COPD, meeting appropriate criteria, are offered an effective pulmonary rehabilitation programme. National Institute for Health and Clinical Excellence Centre for Clinical Practice Quality standards programme COPD downloaded 1/10/10 www.dh.gov.uk/en/Consultations/Liveconsultations/DH_112977

7. First task: mapping of PR across London No London /national database or reporting system Reliant on local knowledge of what services /gaps present Commissioned as separate service? SLA / LES? Part of integrated pathways and services? Location of programmes – gym, hall, hospital Types of programme – cohort / rolling Duration, content, routine/post admission, culturally appropriate Efficiency – waiting times, DNA / UTA, % completed (what is completion?) Referrals as % of COPD population, repeat referrals, maintenance? Outcomes

8. Where we want to get to Provide standards/framework of PR tailored to London needs GP Commissioning – have dialogue and shape services PR as cornerstone of respiratory services Improve accurate diagnosis, case finding Increase referrals from primary care Promote PR and educate primary care on ‘ selling ’ PR to population Access for patients – ease, cultural awareness, timely Commission for value: redirect respiratory funds