1. IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist

2. Bath & North East Somerset PCT

3. Outline Commissioning COPD services – primary or secondary care led? Service description Reflection

4. Changing expectations of provision and service Provider centred Episodic Fragmented Paternalistic care Limited services Patient centred Community provision Continuity of care Self management End of life care, Pulmonary Rehab etc

5. COPD in BANES Aug ‘07BANES Strategic Development Implementation Group formed July ’08Commissioning recommendations produced Dec ’08BANES intermediate services put out to tender May ’09Bath & North East Somerset PCT Royal United Hospital, Bath awarded tender Dec ’09IMPACT service start date

6. Outline Commissioning COPD services – primary or secondary care led? Service description Reflection

7. Where do intermediate care services fit in? Intermediate COPD service Primary care Secondary care

8. Intermediate care services - ‘teams without walls’ 1 1 Royal College of Physicians, 2003 Primary care Secondary care IMPACT service IMProving Access to COPD Therapies

9. Intermediate care services - IMPACT Primary care Secondary care IMPACT service Accessible Integrated Experience Quality assured Safe Effective

10. Outline Commissioning/tendering process COPD services – primary or secondary care led? Service description Reflection

11. IMPACT - staffing 1 WTE Band 7 physiotherapist 2 WTE Band 6 nurse 1 WTE Band 6 physiotherapist 0.5 WTE Band 3 rehab assistant 1 WTE Band 3 administrator 0.2 WTE Respiratory Consultant

12. IMPACTIMPACT GP referral Oxygen assessment Community COPD clinics Early supported discharge Primary care referral Secondary care referral Self referral Medication optimisation Other community services Pulmonary rehabilitation

13. COPD patients often have multiple admissions Royal United Hospital, Bath data (2006/7)

14. IMPACTIMPACT GP referral Oxygen assessment Community COPD clinics Primary care referral Secondary care referral Self referral Education & training for healthcare professionals Medication optimisation Other community services Pulmonary rehabilitation All hospitalised patients

15. Integrated working - an improved experience for patients Secondary care GPs Palliative care Locality teams Smoking cessation clinics Community hospitals Voluntary organisations IMPACTIMPACT Secondary care IMPACTIMPACT

16. IMPACTIMPACT GP referral Reduced preventable admissions and improved patient experience Oxygen assessment Community COPD clinics Early supported discharge Primary care referral Secondary care referral Self referral Education & training for healthcare professionals Medication optimisation Other community services Pulmonary rehabilitation

17. Outline Commissioning COPD services – primary or secondary care led? Service description Reflection

18. Impact of IMPACT Challenges

19. April – Oct 2010 110 patients accepted for admission avoidance 75 patients accepted for ESD 121 patients accepted for PR 121 patients have undergone oxygen assessments –75 prescriptions unchanged –38 prescriptions altered –8 prescriptions withdrawn

20. Summary Commissioning COPD services – primary or secondary care led? Service description Reflection

21. Thank you for listening Contact: Claire.Bullard@banes-pct.nhs.uk Tel: 07540 674724