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Walthamstow West PBC Consortium and GSK
Shortlisted for the NICE 2011 Shared Learning Award

Walthamstow West PBC Group wanted to set up a community led intermediary care service to increase provision of COPD care in the community setting and integrate into existing care pathways. Dr Ivbijaro, Chair of Walthamstow COPD Pilot, and a GSK Integrated Healthcare Manager identified the opportunity for GSK and Walthamstow West PBC Group to work together through a Joint Working agreement to address this challenge.

PBC Group People

The implementation of the Joint Working project was overseen by the support of a dedicated Steering Group, with members from Walthamstow West PBC Group, NHS Waltham Forest, Whipps Cross Hospital Trust and GSK. The implementation process involved creation of a community led intermediate COPD care service, development of a patient pathway and treatment protocol developed in line with NICE COPD guidelines, and a bespoke training programme to up skill Health Care Professionals to deliver NICE standards of care.

The Challenge

COPD is a significant burden on the Total Health Economy, with the disease currently the UK’s fifth biggest cause of mortality1 and second most common cause of emergency admissions2.

At the time of project set-up, NHS Waltham Forest and Walthamstow West PBC Group reported a lower than average prevalence for diagnosed COPD (0.9% v 1.4% national average)3, with the actual prevalence rate thought to be closer to 4.1%4.

NHS Waltham Forest ranks 148 out of 152 Primary Care Trusts Nationwide for COPD5. This is based on length of stay, number of emergency admissions and number of emergency bed days for patients with COPD. There is a documented need to reduce health inequalities across NHS Waltham Forest6. Before project initiation, there was no intermediary COPD service within NHS Waltham Forest.

The Objectives

Patient
  • Improve the quality of the annual COPD review by implementing NICE COPD guidelines
  • Increase patients’ understanding of their condition and treatment options
NHS
  • To ensure adherence to the evidence based care pathway & treatment protocols. Patients to be treated in line with NICE COPD and local NHS Waltham Forest guidance
  • To increase the number of newly diagnosed COPD patients
  • More appropriate use of resources e.g. increased appropriateness of referrals to secondary care, reduction in unplanned admissions to secondary care, resulting in ‘care closer to home’
GSK
  • Increased use of appropriate respiratory medicines, including GSK medicines, in line with NICE COPD guidelines
  • Demonstration of how Joint Working between GSK and Walthamstow West PBC Group has improved COPD patient management and experience
  • Increased acknowledgement of the role of GSK in supporting the locality group and NHS Waltham Forest

The Solution

Joint Working involves the pooling of skills, resources and expertise from both parties, and the very first step in the process was to develop a Joint Working business case, which clearly specified the proposition, deliverables, roles/responsibilities, contribution from each party, and key outcomes and measures for patients, Walthamstow West PBC Group and GSK.

The decision was taken to pilot the scheme in 11 practices for 1 year, at which point an evaluation of the pilots success would be carried out, with a view to up-scaling across the whole Primary Care Trust if objectives were met.


The Approach

  • Creation of a community led intermediary COPD Care Service, run 2.5 days per week by an NHS employed Community Respiratory Specialist Nurse and mentored by Professor M. Roberts, the local secondary care Chest Consultant.
  • Development of a patient pathway and treatment protocol by Walthamstow West PBC Group in line with NICE COPD guidelines. This process was led by Professor M. Roberts, the Community Respiratory Specialist Nurse and with the involvement of all participating practices.
  • Installation of the POINTS* patient audit tool in all practices to enable effective prioritisation of COPD patients for review, and the measurement of change from QOF to NICE standards of care.
  • Provision of a lead COPD GP and Nurse, where possible, from each practice to run dedicated respiratory clinics in their respective practices in order to enhance capacity and provide quality reviews in a consistent way across all practices.
  • A bespoke training programme to up skill the lead COPD GP and Nurse within each practice to deliver NICE standards of care, developed together with Professor M Roberts, the Community Respiratory Specialist Nurse and NHS Waltham Forest.
  • Development of an updated local referral pathway for COPD to support appropriate referrals into the COPD intermediary service. This pathway was developed and designed by Professor M. Roberts, Dr Ivbijaro, the Community Respiratory Specialist Nurse and project managed by GSK.
  • Bespoke training to support the lead COPD GP and Nurse within each practice to follow the local guidance and referral pathway into the intermediary service and hospital as appropriate.
  • An Ipsos Mori patient experience survey to measure the quality of the patients’ annual COPD review, to review areas of strength as well as those in which improvements could be made.

Resources Contributed to Project Delivery

Walthamstow West PBC Group GSK
  • PBC Business Manager and Clinical Lead – project management and practice engagement
  • Chest Consultant time and resource to write and deliver a bespoke training programme and input into local guidelines
  • Development of COPD treatment protocol
  • Dedicated respiratory clinics in every participating GP practice
  • Clinical room, equipment and utility costs to be used 2.5 days per week by the Community Respiratory Specialist Nurse
  • PCT Business Review – auditing, project support and reviewing
  • Dedicated project management resource
  • POINTS patient audit tool to enable effective prioritisation of COPD patients for review, and to measure the change from QOF to NICE standard of care
  • Dedicated RCA resource to help develop practice-by-practice bespoke action plans, including training and mentoring, in line with NICE guidelines and patient audit results
  • Health Outcomes Consultant to set project measures, interpretation and analysis of locality data, and evaluation of results
  • Community Respiratory Specialist Nurse contracted 2.5 days per week for 12 months
  • Cost of license for pathway development tool
  • Cost of patient experience survey
Value of Total Contribution = £68,500 Value of Total Contribution = £67,603

Outcomes as of August 2010

Patient
  • The percentage of patients receiving an annual COPD review has increased from 20% to 73% (from 90 patients to 370)7
  • Recording of breathlessness has increased from 18% to 75% in line with NICE standards7
  • 96% of patients were satisfied with the level of service given to them during their check up and felt that the review was thorough8
  • An increase from 43% to 70% in patients having a high understanding of their condition8
  • Patient understanding for the reason of why they have been given a type of medicine has increased by 50%8
  • Whilst the following were not primary objectives of this project, it is of interest that:
  • Patients who were told how to access flu vaccines during their review increased from 26% to 85%8
  • Patients offered pulmonary rehabilitation has increased from 26% to 65%8
  • There was an increase from 20% to 75% of current smokers being told how to access help to stop smoking8
NHS
  • Overall improvement in the quality of patient review to NICE standards from 22% to 56%7
  • The prevalence of diagnosed COPD patients increased from 453 to 508, an increase of 12.1%7
  • A 16% reduction (from 80 to 67) in year-on-year COPD non elective admissions in the period September 2009 to August 20109
  • The cost of non elective admissions has been reduced by 18.6% in the period of September 2009 to August 2010 equivalent to £35,0009
GSK
  • There has been an increase in the proportion of COPD patients with moderate or severe classification receiving ICS/LABA combinations from 65.6% to 75.3% – an increase of 9.7%7. This increase in ICS/LABA combinations is for all ICS/LABA combinations, including GSK ICS/LABA combination licensed for COPD
  • The role GSK has played in supporting the locality group and NHS Waltham Forest is demonstrated in the following quote:
    “GSK involvement has provided support in many forms! Providing valuable audit “POINTS” to track impact of the service/pilot, co-ordinating communication and education meetings and ensuring continued focus”.
    Anne O’Malley, Respiratory Nurse Specialist, Walthamstow COPD Pilot

Key Success Factors

  • Comprehensive business plan written in partnership between GSK and Walthamstow West PBC Group set the scene for true partnership working and shared roles and responsibilities throughout.
  • The close working of Primary, Secondary and Primary Care Trust clinicians and managers within Waltham Forest and GSK to deliver on a jointly owned COPD project with Walthamstow West PBC Group.
  • Establishing a consistent, influential and engaged leadership team that represents all parties who meet on a regular basis and has a shared agenda to review the progress and project milestones.
  • The use of POINTS supported the identification of at risk COPD patients and tracking of improvements in the quality of the patient review in line with NICE standards of COPD care.

Pilot Programme Recommendations and Next Steps

  • Walthamstow West PBC Group has submitted a proposal to NHS Waltham Forest to provide a scaled up version of the current COPD Intermediary Community service.
  • Joint working project between GSK, Walthamstow West PBC Group & NECLES HIEC group to validate diagnosis of COPD in all participating practices started in October 2010
  • Learning from this project has helped accelerate customer interest in working with GSK with future projects across London SHA

*The Patient Outcomes and Information Service (POINTS) is provided by GlaxoSmithKline (UK) Ltd (GSK) and is delivered on behalf of GSK by Quintiles.

References – The Challenge

  1. Death Registrations in England and Wales: 2005, causes www.statistics.gov.uk/downloads/theme_health/hsq30.pdf Accessed April 2011.
  2. Commission for Healthcare Audit and Inspection. Clearing the air: A national study of chronic obstructive pulmonary disease, 2006.
  3. QOF Database 2008 www.gpcontract.co.uk/browse.php?year=8 Accessed April 2011.
  4. Modelled estimates and projections of COPD for PCTs in England, East of England Public Health Observatory www.erpho.org.uk/viewResource.aspx?id=18025 Accessed April 2011.
  5. Disease Management Information Toolkit (DMIT). Department of Health (DH) 2007. www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_074772 Accessed April 2011.
  6. NHS Waltham Forest commissioning case for COPD Pilot.

Sources – Outcome Data

  1. POINTS data reports for 10 practices, 508 COPD patients. Collected and supplied by Quintiles, data analysis by GSK 22nd June 2010.
  2. COPD patient experience survey. Data collected and analysed from 56 patients by Ipsos MORI, October 2010.
  3. Data from NHS Waltham Forest (provided by Frank Hamilton, GP Commissioning Business Manager) November 2010.

For more information visit: www.gsk.com/uk/joint-working or contact UK Customer Contact Centre: +44 (0)800 221 441

To access the Department of Health Joint Working Toolkit visit:
Department of Health Joint Working Toolkit

UK/PPM/0106a/11 - April 2011

Joint Working logo

Department of Health Best Practice Guide

Department of Health Moving Beyond Sponsorship

ABPI guidance notes