impact (bath) – bringing primary and secondary care copd services closer together
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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
0102030405060708090100
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
GPsPalliative careLocality teamsSmoking cessation clinicsCommunity hospitalsVoluntary 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
