Leading change

Practice nurses and respiratory specialist nurses set up the Leeds Respiratory Network to address unwarranted variation in respiratory care across the region. This all stemmed from analysing data identified through the NHS RightCare Atlas of Variation which demonstrated that Leeds had an unwarranted variation with regards to respiratory care and outcomes, especially within primary care.

Where to look

The practice nurses looked at the Atlas of Variation data for the Leeds area, which provided an evidence base demonstrating poorer respiratory outcomes, lower flu vaccination uptake levels, higher hospital admission rates and low levels of smoking cessation practice when compared to a large part of the rest of the country. Practice nurses also noted that patients at practices across Leeds had differing levels of review. They recognised an opportunity to develop services so that they could improve patient outcomes, experiences and use resources better.

What to change

Practice nurses analysed the data in detail to see where improvements could be made, speaking with surgeries across the city to identify current practices and gaps. They identified that an education package to support practice nurses to complete a comprehensive respiratory review and to be confident of the quality review process in identifying symptomatology and responding to patient need was needed, to standardise practice and support implementation of the evidence bases for respiratory care.

Linked to the patient outcomes was also a staff experience element. The practice nurses identified that local practice nurses were, at times, isolated due to the nature of their work so were not always  aware of new developments which could also contribute to variation in their practice. The Leeds Respiratory Network was set up to tackle both of these aspects, to develop skills and confidence and to reduce unwarranted variation in practice.

How to change

The practice nurses established a series of educational and networking events to address the variation they were seeing. They developed an email distribution list to ensure appropriate guidance and resources were cascaded in a timely fashion so that nurses felt supported and fully equipped to provide a quality respiratory review. These avenues of correspondence are also supported via a Facebook page and a Twitter page set up by the group which are also utilised to provide educational support to other nurses. Information regarding respiratory care, leadership and positive culture development were included in the content in order to support members of the network to be empowered to address unwarranted variation themselves and remain confident patient advocates in practice.

Support has been provided by the Primary Care Respiratory Society, particularly in signposting the practice nurses to resources which help with mentorship and the network of nurses across the area have championed the approach and cascaded information on educational meetings and other events. The network has continued to grow, with members including nurses from primary care, secondary care, community prison nurses, school nurses, speech and language therapists, pharmacists – all healthcare professionals interested in respiratory care.

The Respiratory Network includes a specific educational approach for health care professionals, which was developed by the practice nurses. Free educational meetings were organised and social media accounts set up, which the nurses use to keep professionals up to date as new guidance and resources become available – they are striving to facilitate information sharing. The information shared has helped not only to improve the quality of care that patients receive, but also to standardise the care delivered across the region. The practice nurses are now working with a collaboration of 8 GP practices in Leeds to help standardise respiratory care and reduce unwarranted variation.

Adding value

The overarching aim of this project was to advocate and enhance the quality of respiratory review, namely to standardise the review according to quality guidance shared through the educational groups and correspondence. The email distribution list has several hundred professionals as active users and there are already over 1500 followers on Twitter. Two full-day conferences have been run with national speakers engaged to support the delivery of standardised high-quality care to patients.

Baseline data has been collected and an evaluation will be undertaken in a year (end of 2018) to quantify the impact of the work. Early anecdotal feedback has been very positive as to improved outcomes, experience and use of resources.

Better outcomes – The guidance and educational tools are used to support staff to deliver high quality care which is intended to enhance patient outcomes for respiratory symptoms – the scheduled evaluation (end of 2018) will provide more information on this parameter, utilising the NHS RightCare data packs.

Better experience – Evaluation forms from the educational meetings and other correspondence have always been very positive. Staff reportedly feel more knowledgeable, have better access to available resources and feel part of a support network that may previously have been more remote or harder to access.

Better use of resources –The work has also helped to reduce costs in practice by virtue of less appointments being needed by patients (comparative data to be published in the evaluation) and examples are routinely shared with the network so that good practice can be replicated elsewhere. Continued data analysis will support this process further.

Challenges and lessons learnt for implementation

The practice nurses have experienced that opening communication lines between colleagues across the region who are delivering respiratory care has enhanced discussion(s) and can empower nurses to share good practice examples and some of the impact the changes have made.

It has been difficult to monitor the impact that has been made especially as data sources have changed over time, so post implementation data is particularly difficult to access. Anecdotally however, the teams feel the changes have reduced the unwarranted variation and supported primary care nurses and teams to provide high quality respiratory care to their patients. Over time, data will be evaluated to empirically measure the improvements that have been made.

The team are currently in the process of establishing a social enterprise to take this initiative further forward and support high quality care in a range of settings.

Find out more

For more information contact:

• Sarah Anderson, Nurse Practitioner or Melissa Canavan, Respiratory Nurse Specialist, Respiratory Care Solutions, Lingwell Croft Surgery, Leedsrespiratory.network@nhs.net