Respiratory care in Cheshire and Merseyside

Richard McCarthy is Programme Director for the Urgent and Emergency Care Cross Cutting Theme, which sits under the Cheshire and Merseyside Health and Care Partnership.  The programme board has identified the respiratory pathway as a priority area for them.  As part of a national focus on Respiratory Care by NHS England-Improvement through their social media account, Richard has provided an overview of the work they are doing.

Respiratory illness ranks as the programme of second highest unwarranted variation for Prescribing Spend and third highest for Bed days and Non-Elective Spend across the country. One of the main focuses of the NHS Long Term Plan is better care for major health conditions and as the UK’s third biggest killer, affecting one in five people in England, Respiratory Disease is one of them. The Urgent and Emergency Care programme board has recognised that the respiratory pathway is a priority across Cheshire and Merseyside.

Good respiratory health is key to having a healthy population, and to achieve this, we have been reviewing the respiratory pathway across organisations, to identify areas of respiratory care in Cheshire and Merseyside that can be improved, and areas of care which can be used as good practice models.

There are many areas in Cheshire and Merseyside with good practice models for supporting patients, such as the Knowsley community service, which is a shining example of how integrated care can benefit respiratory patients. There is also a hospital admission avoidance service currently being piloted at Whiston Hospital, funded by the Urgent & Emergency Care Network.

However, there is widespread variation in care models within Cheshire and Merseyside.  We have commissioned a review, with support from RightCare, to identify improvements that could be made to better achieve outcomes for patients and reduce costs.

Encouragingly, a significant number of the CCGs in Cheshire and Merseyside have respiratory disease as a RightCare priority in their plans, which acknowledges the importance of making changes for the benefit of patients.

What are we doing?

We all know that there is a national workforce shortage; in Cheshire and Merseyside we made a bid to the Health and Care Partnership Transformation Fund to make maximum use of a workforce opportunity to employ qualified Physician Associates (PAs).  PAs are a new type of healthcare professional who, while not a doctor, work to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision.  We have now appointed eight PAs to work across Cheshire and Merseyside, specifically within respiratory care.  Their role is to work within primary care settings, to support doctors in the diagnosis and management of patients with respiratory illness, giving a range of benefits including savings from changes to current prescribing regimes and admission avoidance.

We also secured funding to appoint a Clinical Lead – Dr Sarah Sibley, Consultant Respiratory Physician and Clinical Lead for Community Respiratory Services at Liverpool Heart and Chest Hospital. Dr Sibley has been leading a review of current practice, identifying opportunities for improvement.


We have been engaging well with all Primary and Secondary Care providers, Medicines Management Teams and Commissioners and in May, we presented at the North STP respiratory event. We held a workshop on the 18 July, to share the results of the review, to inform plans for the coming winter, but also more longer-term.

Our team is working really hard to make sure that the people of Cheshire and Merseyside have access to the best respiratory care in the community, whilst also being mindful of NHS finances. It’s a balancing act that NHS teams up and down the country are managing, including here in Cheshire and Merseyside.

For more information about the programme, please contact:

Richard McCarthy, Programme Director,Cheshire and Merseyside Urgent Care Cross Cutting Theme