Key contacts

Clinical Director: Dr Vincent Mak, Consultant Physician in Integrated Respiratory Care, Imperial College Healthcare NHS Trust. V.Mak@nhs.net

NHS Long Term Plan – Respiratory Disease

The NHS Long Term plan has set respiratory disease to be a national priority.  Breathing disorders affect a significant portion of the population impacting on their quality of life.  This is associated with high costs to the NHS as well as high socioeconomic cost. It is estimated that respiratory disorders in the UK costs the wider society nearly £10 billion a year.  Respiratory disease affects one in five people in England, and is the third biggest cause of death. Hospital admissions for lung disease have risen over the past seven years at three times the rate of all admissions generally and remain a major factor in the winter pressures faced by the NHS.

The NHS London Respiratory Clinical Network has been established to bring together a multidisciplinary team of experts in respiratory disease from across the diverse areas of London to deliver the NHS Long Term plan for Londoners.

The NHS Long term plan has identified several focus areas in respiratory disease:

1. Accurate and Timely Diagnosis
2. Correct prescribing and correct use of medications
3. Pulmonary Rehabilitation and Activity
4. Treating tobacco dependency
5. Flu and pneumonia vaccination
6. Other areas of focus

2019/2020 focus areas

Accurate and Timely Diagnosis

Why is this important?

• Discrepancy between predicted and reported prevalence for COPD and asthma
• Nationally – diagnosis of COPD and asthma not accurate – 50% of patients with COPD may not have COPD – potential for incorrect management
• Diagnosis of COPD often at late stage of disease

What do we intend to do?

• Case finding for COPD targeting smokers in the community
• Review existing diagnosis of patient with COPD/Asthma
• Review and accurate diagnosis for patients with respiratory symptoms

How are we going to do it?

• Encourage use of virtual registry reviews by specialists in community settings
• Develop Diagnostic Hub model based around CCG GP networks of 30—50000
• Encourage use of group consultation for early disease

What are the benefits for patients/NHS?

• Improved accurate and timely diagnosis places patient on correct pathway earlier – may prevent developing more severe disease/exacerbations
• Reduce costs in long run – avoiding non- elective care, more expensive care

Correct prescribing and correct use of medications

Why is this important?

• High rate of inappropriate prescribing for disease or disease severity
• Incorrect diagnosis leads to incorrect medications
• High rates of poor adherence to medications and poor inhaler technique
• Overuse of high dose inhaled steroids (which is both costly and harmful)

What do we intend to do?

• Direct appropriate prescribing
• Perform more checks on appropriateness, adherence and technique

How are we going to do it?

• Encourage use of virtual registry reviews by specialists in community settings
• Engage practice based pharmacists to conduct medication reviews
• Increase use of community pharmacy Medicine Use Reviews and New Medicines Service

What are the benefits for patients/NHS?

• Appropriate medication and improved adherence and inhaler technique will improve disease control of symptoms and quality of life. Good control of disease may reduce exacerbations and non-elective admissions and reduce harm.
• Reduce medications costs and emergency care costs.

Pulmonary Rehabilitation and Activity

Why is this important?

• Grade A evidence for improved QoL and reduced non elective admissions
• Low referral and completion rates
• No alternative for those not suitable/not able to complete

What do we intend to do?

• Improve referral and  completion rates
• Encourage provision of alternatives to PR (e.g. singing for breathing)

How are we going to do it?

• Audit availability of alternatives to PR and encourage use
• Encourage use of virtual registry reviews by specialists in community settings to find suitable patients/New QoF indicators

What are the benefits for patients/NHS?

• Improved activity and knowledge may reduced exacerbations/non-elective admissions, improve QoL.
• Reduce costs

Treating tobacco dependency

Why is this important?

• Huge variation of provision of services across London in community and secondary care
• Not clear what Local Authority plans are for smoking services
• Not clear what impact of secondary care CQUIN has been

What do we intend to do?

• Align services across care providers
• Ensure all who work in care trained in stopping smoking

How are we going to do it?

• Audit of secondary care provision of services/stop smoking champions
• Audit of local authority plans for provision of stop smoking services
• Lobby for mandatory training for all involved in care

What are the benefits for patients/NHS?

• Managing tobacco dependency becomes everyone’s business.
• Reduce tobacco related morbidity/mortality and costs

Flu and pneumonia vaccination

Why is this important?

• Important intervention in at risk groups and HCPs
• Common cause of non elective admission
• Huge variation in take up in secondary care and across London

What do we intend to do?

• Investigate reasons for non-take up of vaccinations in patients and HCPs
• Increase vaccination rates in HCPs

How are we going to do it?

• Investigate outcome of Health and Wellbeing CQUIN in healthcare trusts
• Look for evidence on causes of poor take up and develop strategies to improve

What are the benefits for patients/NHS?

• Reduce non elective admissions from ‘flu and pneumonia
• Reduce NHS staff sickness in ‘flu season and NHS resilience

Other areas of focus

• Air quality and pollution
• Sustainable prescribing