© Imperial College LondonPage 1 Consultants in Integrated respiratory care? Martyn R Partridge...

© Imperial College London

Consultants in Integrated respiratory care?

Martyn R PartridgeProfessor of Respiratory MedicineNHLI at Charing Cross

“Researching the delivery

of respiratory healthcare”


Primary Care

The Patient

Secondary Care

Tertiary Care

The Traditional Model of Health care


Primary Care

The Patient

Secondary Care

Tertiary Care

Who provides care in each sector?


Traditional care

Majored on diagnosis and the writing of prescriptions


Primary Care

The Patient

Secondary Care

Tertiary Care

Who provides care in each sector?


Traditional care

Majored on patient care


Primary Care

The Patient

Secondary Care

Tertiary Care

Who provides each level of care?


Late 1970s /Early 1980s: In primary and secondary care

© Imperial College LondonPage 14

The evolving model of healthcare

The patient

Nurses, MCPs, and HCAs

GPs with a special clinical interest

Resp Physicians

TertiaryCare

Acute medicine specialists


The evolving model of healthcare

The patient

Nurses, MCPs, and HCAs

GPs with a special clinical interest

Resp Physicians

TertiaryCare

Acute medicine specialists


Need to stop thinking about “Primary” and “Secondary” Care

www.mkgeneral.nhs.uk •witchdoctor.wordpress.com


Need to stop thinking about “Primary” and “Secondary”Care

www.mkgeneral.nhs.uk •witchdoctor.wordpress.com

Ambulatory patients Patients needing hospital beds


Who cares for these ambulatory patients?

Doctors

Nurses

Physios

MCPs

HCAs


But even within a team, and whether in hospital or the community the patient should have access to specialist care.


Hammersmith and Fulham PCT Community Respiratory Assessment Unit (CRAU)

Dalling Road

Hammersmith Road

Uxbridge Road

Talgarth Road

Fulham Road

CHARING CROSS HOSPITAL

HAMMERSMITH HOSPITAL

Falkland House Health Centre

Millson Road Health Centre

Richford Gate Primary Care Centre

St. Dunstans Clinic

Ashville Surgery

Munster Road

Charing Cross Hospital

Lillie Road

Parsons GreenHealth Centre

Hammersmith Bridge Road Surgery

White City Health Centre

The Bush Doctor

1) Community Respiratory Assessment Unit

2) Respiratory Nursing Service

3) PCT funded, nurse run, hospital based oxygen

assessment service

4) Pulmonary Rehabilitation programme

5) Consultant in Integrated Respiratory Care

0

5

10

15

20

25

30

35

40

45

50

Doctors based incommunity

setting (2008)

Doctors based incommunity

setting (2018)

Nurses incommunity

setting (2008)

Nurses incommunity

setting (2018)

Per

cen

tag

e

25%

47%

22%

40%

Consultant in Integrated Respiratory Care: Responsibilities (1)1) promote integration of respiratory care between primary and

secondary care2) provide medical leadership for the current integrated services with

a special reference to the community respiratory assessment unit (CRAU), the oxygen assessment service, pulmonary rehabilitation and medical support to the respiratory nursing team (including TB specialist nurses within the community).

3) support spirometry services in the community for practices which wished to provide their own service, rather than utilise CRAU and to ensure that standards of spirometry were adequate in terms of health and safety issues and interpretation of results

4) help in the selection of patients for pulmonary rehabilitation and to lead in the development of services for pulmonary rehabilitation in the community

5) provide medical leadership to the COPD admission avoidance and early discharge schemes, and to act as a link between the acute hospital COPD services and the nursing team

.


Consultant in Integrated Respiratory Care: Responsibilities (2)

6) act as a learning resource and to provide continuing education for primary care physicians, practice and district nurses and community matrons

7) trial and evaluate outreach clinics (place of work teaching) and a community-based consultant clinic.

8) assess and manage patients with complex breathlessness in the community, liaising where appropriate with the cardiac services

9) work with others to promote better end of life care for those with severe lung disease

10) work with others to develop advanced respiratory support in the community for those needing home ventilation


Consultant in Integrated Respiratory Care:The Questions:

1. How do we evaluate such a post?

2. Can one person alone provide such a role?

3. Will there be an iceberg effect?

4. How do we extend service optimally beyond just being a COPD service?

5. If successful what training should future entrants to this sub-speciality have?

6. Is the Consultant appointment an irrelevance and is integration alone the priority?


Thank you

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© Imperial College LondonPage 1 Consultants in Integrated respiratory care? Martyn R Partridge...

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