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DISCUSSION
i
H
ealth care is changing faster than ever before
— at least that’s what we are constantly being
told from above. The
Five Year Forward View
(NHS England 2014) acknowledges that with an ageing
population, who are more and more affected by lifestyle-
related disease, demands on healthcare services are
going to become unsustainable and so proposes radical
solutions that focus on improving people’s lifestyle-
related behaviour, partnership with people, patients,
carers and communities, as well as new models of care.
The management of long-term conditions is, of course,
central to this, necessitating ongoing relationships
between healthcare professionals and patients, rather
than just single episodes of care.
It is here that respiratory disease management begins
to raise its head, as caring for people with, for example,
chronic obstructive pulmonary disease [COPD] or
asthma, makes up a large part of primary care caseloads.
Indeed, the predicted rise in prevalence of chronic
respiratory disease over the next 20–30 years can only
add to the burden on healthcare professionals, who are
trying to provide the best patient-centred care possible,
while also working within tight financial constraints.
In this first
Respiratory Care Today
discussion, we ask
two expert respiratory care practitioners, Carol Stonham
and Monica Fletcher, for their views on the current state
of respiratory care provision, whether clinicians have the
right skills and training and, if not, what they need in the
future. The results make for interesting reading...
The state of
respiratory
care today
Carol Stonham,
Queen’s Nurse,
senior nurse, Minchinhampton
Surgery and lead nurse, Primary Care
Respiratory Society UK (PCRS-UK)
Monica Fletcher,
OBE
,
chief
executive of Education for Health,
the international medical education
charity; fellow of the Queen’s
Nursing Institute
WHAT DO YOU THINK IS THE CURRENT STATE OF
RESPIRATORY CARE PROVISION IN PRIMARY CARE
Care provision in primary care is variable.There are some
pockets of excellent care being delivered to patients both
locally and regionally — this has been demonstrated by
some practices being awarded the Primary Care Respiratory
Society Quality Award for the organisation and delivery of
their respiratory services, for example. Unfortunately, there is
no consistency in the care offered or the standards to which
clinicians should aspire.The
National Review of Asthma Deaths
(Royal College of Physicians [RCP], 2014) highlighted issues
around organisation of care, training and prescribing that
needed to be improved in asthma care, and the same are
likely to be found in other respiratory conditions. In many
practices much of the care has been delegated to the nursing
team which, as long as the nurses are trained, updated
regularly, competent and confident is not wrong, although
this can lead to the de-skilling of GPs, which may need to
be addressed. An unwell patient may need to see a GP in
an emergency situation, so all teammembers should be
competent in dealing with respiratory patients.
CS
Over the past 25 years the amount and complexity of
community respiratory care has grown considerably.
This has been driven by the production of high-quality
clinical guidelines and the expansion of clinical services,
which has put nurses at the heart of respiratory care, from
diagnosis through to management. Over the years the
model of nurse-led care has been incentivised through the
General Medical Services (GMS) contract. This has been
underpinned by the availability of high-quality accredited
education programmes such as that provided by Education
for Health and Respiratory Education UK.
However, the quality of care is not universal and like all
care provided in general practice, it is dependent on the skills
and expertise of individuals within the team. Nurse-led care
is an excellent model and one that is revered by many other
countries across the world. However, it is important that
nurses are supported by well-qualified GPs and have access
to ongoing education and training.
MF
WHAT DRIVERS ARE NEEDED TO ENSURE THAT
MISDIAGNOSING ASTHMA AND/OR POOR
PRESCRIBING BECOME A THING OF THE PAST?
IS THIS ACHIEVABLE?
Education of healthcare professionals in correct diagnosis
using current guidelines. Unfortunately, if guidelines are
complicated or there are competing guidelines, there
may be confusion regarding which ones are correct.The
National Institute for Health and Care Excellence (NICE)
is currently reviewing asthma diagnosis and its draft
guidelines are causing some controversy, but actually they
are not that different to the BritishThoracic Society/Scottish
Intercollegiate Guidelines Network (BTS/SIGN, 2014)
guidelines if read in detail.They do, however, recommend the
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RESPIRATORY CARE TODAY
2015,Vol 1, No 1
?
?