Community lung specialists help GPs to cut COPD burden and save six-figure sums

GPs could work alongside specialist lung teams in the community to improve respiratory health, slash hospital admissions and reap cost savings worth six-figure sums, according to the British Thoracic Society.

The British Thoracic Society (BTS) has called for more funding to be allocated to specialist lung teams working in the community after a number of local schemes helped improve patient health and cut hospital and prescribing costs.

The initiative allows GPs to work closer with lung experts to improve patient health and quality of life as well as ‘significantly reducing’ the high number of patients with chronic lung disease being admitted to hospital during the winter, it said.

The society is now calling on NHS England to meet and discuss the projects with a view to funding a number of dedicated ‘healthy lung’ pilots as part of their vanguard programme.

The number of hospital A&E admissions for respiratory disease outstripped those for heart disease every year between 2008/9 and 2012/13 – in addition to those for digestive, musculoskeletal and genitourinary problems.

Respiratory disease also has a strong seasonal effect – patients with chronic lung conditions are particularly vulnerable to respiratory infections during the winter. Respiratory diseases were the underlying cause for a third of all excess deaths in England and Wales during winter 2014/15.

Respiratory health

BTS argued that providing expert, specialist care alongside GP care in the community would help improve patients’ health earlier, alleviating strain on hospitals.

The teams would provide ‘a specialist-led range of medical, psychological and lifestyle support’ to give patients ‘the most effective treatment and support in the community’, it said.

A number of local systems around the country have already reaped success. The Whittington Health COmmunity REspiratory (CORE) multidisciplinary team in Haringey and Islington is estimated to have helped save £58,000 in seven months by avoiding hospitalisation of patients with severe COPD.

This scheme particularly focused on helping patients quit smoking, and a recent review suggests half of the patients involved in the scheme have managed to quit.

Another scheme, the King’s Health Partners Integrated Respiratory Team, is thought to have saved £200,000 in south east London by bringing about a ‘significant reduction’ in high dose ICS prescribing after reviewing COPD patients’ case notes. The team is a mix of respiratory specialists and GPs.

Dr Justine Hadcroft, consultant respiratory physician and member of the BTS said: ‘During the winter we often see headlines about NHS hospitals trying to cope with large numbers of often older people with chronic conditions being admitted to hospital as their health worsens. Lung disease accounts for the lion’s share of these admissions.

‘One key way of tackling this issue right now is to treat and support respiratory patients more effectively in their own homes, or closer to home. This can help prevent their health worsening and the need for hospital treatment in the first place.

‘A number of innovative projects already exist where lung specialists are using their expertise outside the hospital gates, in partnership with colleagues in the community, to deliver better patient care and reduce NHS costs – but we need more.’

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