Journal of General Practice Nursing

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Most people don’t understand
the terms ‘primary’, ‘secondary’,
‘community’ and ‘social’ care — these
words are relatively meaningless.
People want coordination and care
based on best practice. Patients have
little interest in organisational or
institutional priorities or mergers.
They want organisations and professionals not to argue between
themselves, or provide differing messages. They expect all
professionals to work together as a ‘single team’, which is based
around them, and they want services to work together at the
time they are needed — care delivered without delay. Most
understand that they may need a variety of professionals and
support services, but within this they want a single trusted point/
person coordinator.
I agree that if care were fully integrated improvements would
be seen in respiratory care. But the author is right, the current
health and social care systems in England are not well integrated
and so the challenges to achieve integration will require
widespread bold professional and organisational changes to
reinvent the organisational culture of the NHS.
Rebecca Sherrington, nurse consultant, respiratory medicine, Health and
Social Services Department, Guernsey, Channel Islands
RCT
skills and a real passion to achieve
the best possible outcomes for the
community. Discussions about the
allocation of funding also need to
take place between commissioners
and providers of care.
A professional cultural shift will
be needed. While nurses have always
worked across all healthcare settings,
for others, i.e. medical consultants,
this will be a new experience. For
some, working in an integrated
way may not be an attractive career
option, while for others it will
present exciting challenges. Clear
clinical governance arrangements
and lines of accountability and
responsibility need to be drawn
up to ensure a safe and robust
service for both those receiving and
providing care.
The good news is that within
the respiratory community itself
there appears to be a desire to drive
integrated respiratory care forward,
e.g. 60% of healthcare communities
are reported to have an integrated
care pathway for COPD (Stone et al,
2014). This is certainly a step in the
right direction. The need to develop
and support skilled respiratory
practitioners has also been recognised
by the British Thoracic Society (BTS;
, which has
researched the role, training and
support needed for these integrated
posts and is developing resources to
support the provision of integrated
respiratory care.
We have also seen the
establishment of several integrated
teams across the country, which have
resulted in locally enhanced services,
enabling primary and community
teams to be supported by respiratory
specialists. Due to improved clinical
knowledge, a reduction in admissions
to hospital and better patient
outcomes have been seen (NHS
England, 2014).
Despite the enormity of the
challenge, integrated respiratory
care offers an exciting opportunity
for nurses to provide an holistic
approach that will be delivered
throughout the disease trajectory
and across the traditional healthcare
settings. Put that way, it seems
that working together may be the
only option.
REFERENCES
All Parliamentary Party Group (APPG)
on Respiratory Health (2014).
Available online:
campaign-appg (accessed 1 May, 2015)
Department of Health (2011) An
outcomes strategy for chronic obstructive
pulmonary disease (COPD) and asthma
in England. DH, London. Available
online:
publications/an-outcomes-strategy-
for-people-with-chronic-obstructive-
pulmonary-disease-copd-and-
asthma-in-england
Future Hospital Commission (2013)
‘Future hospital; caring for medical
patients’. A Report from the Future
Hospital Commission to the Royal
College of Physicians . Royal College of
Physicians, London
NHS England (2014) NHS Five Year
Forward View. NHS, England, London.
Available online: .
uk/ourwork/futurenhs/ (accessed 1
May, 2015)
Robertson R, Sonola L, Honeyman M,
Brooke B, Kothari S (2014) Specialists
in out-of-hospital settings: findings from
six case studies. King’s Fund, London.
Available online: .
org.uk/publications/specialists-out-
hospital-settings (accessed 1 May,
2015)
Royal College of Physicians (2014) Why
asthma still kills: the National Review
of Asthma Deaths (NRAD) Confidential
Enquiry report. Royal College of
Physicians, London
Stone RA, Holzhauer-Barrie J, Lowe D,
Searle L, Skipper E, Welham S, Roberts
CM (2014) COPD: Who cares? National
chronic obstructive pulmonary disease
(COPD) Audit Programme: Resources
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National Organisational Audit report.
Royal College of Physicians, London
RESPIRATORY CARE MATTERS i
RESPIRATORY CARE TODAY 2015,Vol 1, No 1 7