Integrated Nurse Led Respiratory Service

Sandy Walmsley RGN, MScLead Respiratory Nurse Specialist –Solihull Care Trust

Co Respiratory Clinical Lead – West Midlands SHA

Session Overview

Background

Current service

Future projects/developments

Reflections

How did it all start?Offered job in September 2005

Remit was to initiate Pulmonary Rehabilitation in Community

Funding also available for full time physiotherapist

If at first you don’t succeed……

Physiotherapist who was originally appointed declined the offer

After much discussion a Service level Agreement (SLA) was agreed with local Acute Trust

Friends need to be made!

GPs

Practice Nurses

Consultants

Commissioners

Professional Executive Committee (PEC)

Patients

Progress…….

Referrals started to come in from GPs, Practice Nurses & consultants

Nurse led clinics initiated to assess patients for PR

Community PR successfully initiated

But………..

More staff were needed to help manage referrals

What happened next?

Presentation of business case to PEC

Agreed to appointAnother nurseOccupational therapistAdmin assistant

Community Pulmonary Rehab expanded

Additional site identified

Maintenance classes commenced at both sites

Local Breathe Easy group “born” out of rehab classes

Admission figures from Pulmonary Rehabilitation

But quality was needed too

Further presentation to PEC to request yet more funding

Funding for provision for COPD diploma for1 practice nurse and1 GP from every surgery

Further funding awarded from SHA with proviso that training be offered to hospital nurses too.

Integration, integration, integration!

After lengthy discussions with consultants & physiologists

Business case submitted for 2 blood gas analysers

Pathway developed for integrated oxygen assessment pathway

Post discharge oxygen pathway

Rationalising oxygen use to improve patient safety and to reduce waste

The IMPRESS step-by-step guide

Partnership working

One GP consortia decided to address COPD with LES.

Agreed to fund further staff for teamBand 7 nurse2 HCAs

Early supported discharge to be initiated

Integrated discharge planning with acute care

Early Supported Discharge Figures & Trends

NHS

.........where to now?

The White Paper

• This represents a significant shift in focus for the NHS – moving away from monitoring the processes of care to monitoring the results of the care and treatment provided to patients

• Sets out the Government’s strategy for the NHS

Transforming Community Services

Integrating with acute care

Preparations have already started

Meetings with acute & community teams

Reviewing current pathways with all stakeholders

Current Projects

Working closely with Smoking Cessation Services to identify “Missing Millions”

One of 6 National End of Life projects. Working with Specialist Palliative Care Team

We CAN do it!!Draft consultation document & NICE Guidelines

foundation for quality care

Collect your data & benchmark with similar PCTs to use as rationale for service improvement and delivery

Contact SHA Leads for help & support

Showcase your service

Identify “friends” and share best practice

Together we will get the whole picture