© imperial college londonpage 1 consultants in integrated respiratory care? martyn r partridge...
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Consultants in Integrated respiratory care?
Martyn R PartridgeProfessor of Respiratory MedicineNHLI at Charing Cross
“Researching the delivery
of respiratory healthcare”
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Primary Care
The Patient
Secondary Care
Tertiary Care
The Traditional Model of Health care
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Primary Care
The Patient
Secondary Care
Tertiary Care
The Traditional Model of Health care
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Primary Care
The Patient
Secondary Care
Tertiary Care
Who provides care in each sector?
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Traditional care
Majored on diagnosis and the writing of prescriptions
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Primary Care
The Patient
Secondary Care
Tertiary Care
Who provides care in each sector?
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Traditional care
Majored on patient care
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Primary Care
The Patient
Secondary Care
Tertiary Care
Who provides each level of care?
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Late 1970s /Early 1980s: In primary and secondary care
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The evolving model of healthcare
The patient
Nurses, MCPs, and HCAs
GPs with a special clinical interest
Resp Physicians
TertiaryCare
Acute medicine specialists
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The evolving model of healthcare
The patient
Nurses, MCPs, and HCAs
GPs with a special clinical interest
Resp Physicians
TertiaryCare
Acute medicine specialists
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Need to stop thinking about “Primary” and “Secondary” Care
www.mkgeneral.nhs.uk •witchdoctor.wordpress.com
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Need to stop thinking about “Primary” and “Secondary”Care
www.mkgeneral.nhs.uk •witchdoctor.wordpress.com
Ambulatory patients Patients needing hospital beds
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Who cares for these ambulatory patients?
Doctors
Nurses
Physios
MCPs
HCAs
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But even within a team, and whether in hospital or the community the patient should have access to specialist care.
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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
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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
.
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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
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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?
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Thank you
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