IMPACT (Bath) – bringing primary and secondary care

COPD services closer together

Claire Bullard Respiratory Physiotherapist

Bath & North East Somerset PCT

Outline

• Commissioning

• COPD services – primary or secondary care led?

• Service description

• Reflection

Changing expectations of provision and service

Provider centred

EpisodicFragmented

Paternalistic care

Limited services

Patient centredCommunity provision

Continuity of care

Self management

End of life care, Pulmonary Rehab etc

COPD in BANES

• Aug ‘07 BANES Strategic Development Implementation Group formed

• July ’08 Commissioning recommendations produced

• Dec ’08 BANES intermediate services put out to tender

• May ’09 Bath & North East Somerset PCT Royal United Hospital, Bath

awarded tender• Dec ’09 IMPACT service start date

Outline

• Commissioning

• COPD services – primary or secondary care led?

• Service description

• Reflection

Where do intermediate care services fit in?

IntermediateCOPD service

Primary care Secondary care

Intermediate care services - ‘teams without walls’1

1Royal College of Physicians, 2003

Primarycare

Secondarycare

IMPACTservice

IMProving Access to COPD Therapies

Intermediate care services - IMPACT

Primarycare

Secondarycare

IMPACTservice

Accessible

Integrated

Experience

Quality assured

Safe

Effective

Outline

• Commissioning/tendering process

• COPD services – primary or secondary care led?

• Service description

• Reflection

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

IMPACT

GP referralOxygen

assessment

Community COPD clinics

Early supported discharge

Primary care

referral

Secondary care

referral

Self referral

Medication optimisatio

n

Other community services

Pulmonary rehabilitatio

n

COPD patients often have multiple admissions

0

10

20

30

40

50

60

70

80

90

100

One Two Three Four Five

Royal United Hospital, Bath data (2006/7)

IMPACT

GP referralOxygen

assessment

Community COPD clinics

Primary care

referral

Secondary care

referral

Self referral

Education & training for healthcare

professionals

Medication optimisatio

n

Other community services

Pulmonary rehabilitatio

n

All hospitalised patients

Integrated working - an improved experience for patients

Secondary care

GPs

Palliative care

Locality teams

Smoking cessation

clinics

Community hospitals

Voluntary

organisations

IMPACT

Secondary care

IMPACT

IMPACT

GP referral

Reduced preventable admissions

and improved patient

experience

Oxygen assessme

nt

Community COPD clinics

Early supported discharge

Primary care

referral

Secondary care

referral

Self referral

Education & training for healthcare

professionals

Medication optimisatio

n

Other community services

Pulmonary rehabilitatio

n

Outline

• Commissioning

• COPD services – primary or secondary care led?

• Service description

• Reflection

Reflection

• Impact of IMPACT

• Challenges

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

Summary

• Commissioning

• COPD services – primary or secondary care led?

• Service description

• Reflection

Thank you for listening

Contact: Claire.Bullard@banes-pct.nhs.uk

Tel: 07540 674724