New ways of working improving life for respiratory patients across Gloucestershire

Living with a respiratory condition is hard. Whether it’s mild asthma or a more serious incurable lung condition, these illnesses can dramatically affect the day to day life of patients, making it difficult to get out and about and do the things they enjoy.

The need for regular monitoring means visits to the doctor and hospital clinics are commonplace, and catching a simple virus like a common cold can be extremely serious.

In Gloucestershire, over 50,000 people are currently living with a diagnosed respiratory condition – 41,000 with asthma, 12,000 with chronic obstructive pulmonary disease (COPD) and many hundreds more with other types of lung condition.

As 82-year-old John Hawthornthwaite explains: “When I first got my diagnosis [of incurable lung condition idiopathic pulmonary fibrosis] I became very depressed, I didn’t want to think about the future and what it might mean.”

But he is one of many patients benefitting from a new approach to respiratory illness in Gloucestershire – where health bosses are reconsidering the way services work.

He is currently attending Breathe In Sing Out sessions in Cheltenham run by the charity MindSong, which bring patients together each week not only to sing, but to learn how to rethink the way they breathe and, perhaps most importantly, meet others in the same situation.

He said: “The group has helped me to realise that it’s not all doom and gloom and there are things I can do. My lung function has increased dramatically since I’ve been attending – in the past 12 months it has increased from 65% to 95% – and the companionship the group provides is wonderful. It’s great to know you are going to see everyone each week and it’s good to see how other people are getting on and coping with their conditions too.”

This new approach to respiratory rehab is one of the many improvements being made for patients across the county. Traditional pulmonary rehab (PR) is continuing but patients can now be booked directly on to the system while they are awaiting discharge from hospital, rather than having to be referred back to community teams – an approach which has seen a 20% increase in take-up in the past year.

Carol Stonham, Senior Nurse Practitioner at NHS Gloucestershire CCG, said: “The move to an integrated care system has given us a real opportunity to transform what we’re doing. We could see there was a lot of duplication in the system so we’ve been working to bring everyone more closely together to provide a much more streamlined service for patients.”

The result is a service which brings care closer to home, reduces unnecessary trips to hospital and gets people faster access to the right kind of care.

One of the main areas of focus has been early diagnosis – a key factor in how well people are able to manage their conditions.

Over the past year, 40 GPs and practice nurses have been trained in spirometry (a method of measuring lung function) meaning they are able to make a diagnosis on the spot.

Carol said: “If we’re getting to patients sooner, diagnosing them in the community and helping them to self-manage their condition, we’ll see far fewer people ending up so ill that they need hospital treatment.”

Preventing unnecessary hospital admissions and the complications they can entail is another key element of the improvements.

A new ‘hot service’ that gives primary care staff access to the expertise of respiratory consultants has already averted many unneeded admissions. Staff can call a hotline number, manned by a dedicated respiratory consultant, if they are concerned about a patient. Often phone support is enough but, if a patient does need to be seen, they can be referred directly to one of the ‘hot clinics’ in the respiratory department, meaning no more unnecessary Emergency Department (ED) visits.

Charlie Sharp is one of the respiratory consultants from Gloucestershire Hospitals NHS Foundation Trust involved. He said: “It’s about giving patients that early specialist input. I have received phone calls from our rapid response team, from the ambulance service, from community respiratory nurses, right across the patch really.

“We are certainly better able to review people earlier and prevent them from being admitted unnecessarily.”

The ‘hot team’ are also available to staff within the hospital, helping to speed up discharges for patients. They know they can call the hotline number and get early involvement from the respiratory team, which will ensure a properly supported discharge takes place.

More streamlined working between the hospital and the community, such as this, is key to the service improvements.

Angela Stonham, Integrated Clinical Specialist in Respiratory Care at Gloucestershire Health and Care NHS Foundation Trust said she and colleagues in the community nursing teams had seen a real difference as a result.

She said: “We’re working much more closely with hospital staff. Probably the biggest change has been with the computer system that we use. The hospitals now have access to it, which means we’re more able to share patient details, ensuring a more effective follow-up for patients when they leave hospital.

“The changes are making a real difference to patients as, by being more streamlined, it means we are able to make sure they get seen by the right person, in the right place at the right time.”