impact (bath) – bringing primary and secondary care copd services closer together claire bullard...
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![Page 1: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/1.jpg)
IMPACT (Bath) – bringing primary and secondary care
COPD services closer together
Claire Bullard Respiratory Physiotherapist
![Page 2: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/2.jpg)
Bath & North East Somerset PCT
![Page 3: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/3.jpg)
Outline
• Commissioning
• COPD services – primary or secondary care led?
• Service description
• Reflection
![Page 4: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/4.jpg)
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
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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
![Page 6: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/6.jpg)
Outline
• Commissioning
• COPD services – primary or secondary care led?
• Service description
• Reflection
![Page 7: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/7.jpg)
Where do intermediate care services fit in?
IntermediateCOPD service
Primary care Secondary care
![Page 8: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/8.jpg)
Intermediate care services - ‘teams without walls’1
1Royal College of Physicians, 2003
Primarycare
Secondarycare
IMPACTservice
IMProving Access to COPD Therapies
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Intermediate care services - IMPACT
Primarycare
Secondarycare
IMPACTservice
Accessible
Integrated
Experience
Quality assured
Safe
Effective
![Page 10: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/10.jpg)
Outline
• Commissioning/tendering process
• COPD services – primary or secondary care led?
• Service description
• Reflection
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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
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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
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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)
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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
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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
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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
![Page 17: IMPACT (Bath) – bringing primary and secondary care COPD services closer together Claire Bullard Respiratory Physiotherapist](https://reader036.vdocuments.us/reader036/viewer/2022062516/56649e655503460f94b60307/html5/thumbnails/17.jpg)
Outline
• Commissioning
• COPD services – primary or secondary care led?
• Service description
• Reflection
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Reflection
• Impact of IMPACT
• Challenges
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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
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Summary
• Commissioning
• COPD services – primary or secondary care led?
• Service description
• Reflection