AB018. Improving the management of patients’ assigned COPD treatment (IMPACT): turning risk assessment into practice

Background: North Norfolk Clinical Commissioning Group (NNCCG) comprises of 19 GP surgeries (rural approx. 168,000 patients) and has seen an increase in COPD admissions of 30% 2012–13 and 2013–14.The change in the way Healthcare is delivered in England as a result of the 2012 Health & Social Care Act means that CCG’s are under increasing financial pressure, Social Care budgets have been cut by up to 40% in some regions, and care is becoming increasingly fragmented between different organisations. The five year forward plan set out by the NHS highlights the use of Specialist Primary & Community Care Clinicians as an important way of aligning healthcare, reducing admissions and reducing the inequalities seen in Primary Care across England. Reducing short stay COPD admissions is a priority for this CCG as is reducing inappropriate high dose ICS prescriptions in an area where high dose ICS/LABA combinations are often the single highest prescription cost per practice. Improving patient access to good quality COPD care was an aim as was asking patients what they would find useful when they were acutely unwell with a COPD exacerbation.

Methods: A 7-point risk tool (designed by Respiratory Effectiveness Group) using data extracted by Optimum Patient Care (OPC) from GP clinical systems was used to identify patients at risk from two or more COPD exacerbations and those on high dose ICS who may be suitable for stepping down or stopping ICS therapy. Practices were taught how to use the spreadsheets provided by OPC to maximise the benefits and produce a list of patients at risk of 2 or more exacerbations and additionally those who are at low risk and suitable for ICS reduction or cessation. Fifteen out of nineteen practices took part and mentored clinics were held with DF, VG, or another nurse specialist to improve the management of both groups of patients and to assess the current expertise in each practice. A unified approach across the CCG was encouraged with standardised documents namely self-management plans, step down guidance & high risk patient management. All practices have access to good quality pulmonary rehabilitation and prompt radiology, smoking cessation services.

Results: Q2–3 2016 further data extraction will take place to evaluate impact on exacerbations and prescribing. Patient feedback was used to influence future services, and following on from this work a respiratory network and more focus on high risk patients are planned. This will include standardised respiratory management templates for GP clinical systems, drug formularies, management guidelines and a separate service for high risk patients.

Conclusions: Considerable variation in nurse standards was seen across the CCG during delivery of the mentored clinics with some excellent care & some training needs identified. A unified approach is required and should be part of the restructuring of health care in the CCG in line with the 5-year forward plan set out by NHS England.

Keywords: Chronic obstructive pulmonary disease (COPD); management; Clinical Commissioning Group (CCG)