COPD Specialist Nurse Support in Primary Care

“The support provided by the AHSN throughout the duration of the project was extremely valuable and the team were available throughout to answer any queries which arose throughout the project. Without the AHSN funding DDES CCG would not have been able to provide the level of dedicated support to primary care colleagues”.  Dr Dilys Waller, Durham Dales Locality Lead, DDES CCG

Overview Summary

The Chronic Obstructive Pulmonary Disease (COPD) Nurse Support Project ran from June 2015 – June 2016 and was funded by Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG) and match funded by the Academic Health Science Network for the North East and North Cumbria (AHSN NENC). The project aimed to improve COPD reviews, reduce emergency admissions and ensure spirometry is performed correctly; it was successful in all three areas with 56 patients avoiding emergency admissions.

The aims of the COPD Project were for the Community Respiratory Support Nurse (CRSNs) to engage with practices to:

  • Improve annual COPD review to NICE standard
  • Reduce COPD admissions
  • Ensure all spirometry is performed correctly, community nurses to assist with interpretation.

As part of the wider COPD agenda, DDES CCG monitor practice performance via a COPD monthly metrics tool and a COPD scorecard presenting practice level data on emergency admissions.  This data identifies how practices are performing in the key areas according to NICE 2010 and the GOLD 2016 guidelines.  Both the metrics tool and the scorecard are shared with all practices for information and to action any areas of improvement. These tools have been used as part of the project performance monitoring to understand the impact of the specialist COPD nurse support to primary care, which has reported successful outcomes.

In addition to the main aims of the project, the Clinical Lead and CRSN team have worked together to review and amend a COPD template for practices to complete on their respective clinical systems. The template includes additional information necessary for holistic assessment, ultimately improving care and reducing morbidity.

Challenge/Problem Identified

Prior to commencement of the project, audit information demonstrated wide variation between practices both with COPD annual review and secondary care admission data. Confidence among practice staff was lacking regarding annual review and spirometry in particular, which was not being performed or interpreted to Association for Respiratory Technology and Physiology (ARTP) standards. There were inconsistencies across the board therefore the project set out to improve the overall care of COPD patients.

Actions Taken

CRSN support was provided in all 40 practices to drive up the quality of COPD patient care to achieve the aims outlined above.

Over the duration of the project, three nurses (allocating time equivalent to a whole time equivalent Band 6) were aligned to a locality area of DDES (Durham Dales, Easington or Sedgefield) and spent approximately 1.5 days a week working with practices to support and advise on COPD.  All three nurses built up positive relationships with the GP practices.

Outcome/Progress to Date

As a result of the focused work between primary care colleagues and the CRSN team, the CCG has seen a reduction in COPD emergency admissions, which has resulted in 56 patients avoiding emergency admissions. In comparison to North Durham CCG and Darlington CCG who have been running a similar COPD project, DDES CCG has had the highest reduction (see chart below).

CCG April – March  2015/16 April – March 2014/15 Change in emergency admissions
Darlington 262 279 -17
DDES 1104 1160 -56
North Durham 696 726 -30

The associated cost savings made in relation to avoidance of emergency admissions during the project has totalled approximately £115,920 (average cost of an emergency admission multiplied by the change in emergency admissions). Therefore taking into consideration the investment made, the project has made a cost saving of approximately £75,920.

The overall recording of annual review codes have also increased over the duration of the project, as an example between September 2015 and June 2016, figures rose from 69% to 76%.

Feedback from both GP practices and CRSNs has been extremely positive and all professionals involved felt that the project has led to improved care over the period. Practice staff described the support from the specialist nurses as ‘excellent’ and felt that the project has standardised treatment for COPD, which has been beneficial to both the patients and clinicians.

With regards to diagnostic spirometry, although the standards in relation to maintenance and actual testing have improved, CRSNs did not feel confident to use spirometry traces across DDES to identify patients likely to have COPD. Spirometry is an area which will require review in the near future following the ARTP guidelines which state that every clinician will need to be accredited to perform and interpret spirometry by 31 March 2021.

Benefit

The project has benefited a number of stakeholders.   Primary care staff worked closely with the CRSNs to upskill and broaden their knowledge on COPD.  The CRSN team have also benefited in participating in the project for a number of reasons. The team have used this opportunity to work collaboratively with primary care clinicians to ensure annual reviews are being delivered to NICE standards and also build on existing knowledge and relationships with the practices.

Overall the main benefit of the project would be the way patients’ COPD is managed and monitored in primary care. The improved level of care provided to patients in primary care has continued to reduce secondary care emergency admissions.

Support provided by AHSN

The AHSN provided funding and mentoring to support this project which started in June 2015 and ended in June 2016.

Plans for the future/Spread and adoption

Following qualitative feedback received from the GP practices and the CRNS team who worked on this project, strong views were voiced to continue COPD primary care support.

Future planning of this project has been considered by the CCG and will form part of contracting conversations and will also form part of the new community hubs development in County Durham and Darlington, to ensure the work the community respiratory nurse specialists have completed with primary care clinicians is set to continue. The Community Hubs development will proactively target services at registered patients with complex needs, such as the frail elderly or those with chronic conditions and working more intensively with these patients.

Spirometry is an area which will require review in the near future following the ARTP guidelines that every clinician will need to be accredited to perform and interpret spirometry by 31 March 2021.

Contact Details

NHS: Becky Haynes, Commissioning Manager, Durham Dales, Easington and Sedgefield CCG

Sedgefield Community Hospital, Salters Lane, Sedgefield TS21 3EE

r.haynes@nhs.net    0191 371 3222

Dr Dilys Waller, Clinical Lead, Durham Dales, Easington and Sedgefield CCG

Sedgefield Community Hospital, Salters Lane, Sedgefield TS21 3EE

dilyswaller@nhs.net

Sue Hart, Respiratory Programme Lead, AHSN NENC sue.hart@ahsn-nenc.org.uk

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