Why is it an issue?
COPD stands for chronic obstructive pulmonary disease. This is a term used for a number of conditions; including chronic bronchitis and emphysema. COPD leads to damaged airways in the lungs, causing them to become narrower and making it harder for air to get in and out of the lungs. The most common cause of COPD is smoking. Once a person gives up smoking, they reduce the chances of getting COPD – and slow down its progress should they already have it. Occupational factors, such as coal dust, and some inherited problems can also cause COPD.
With more severe COPD, because of breathlessness, normal activities can become more difficult. COPD can lead to feelings of anxiety because of breathlessness. People with COPD may reduce their activities to avoid becoming breathless. But by reducing activity levels, they become less fit and therefore get breathless even sooner when they try to do any activity. People with COPD may adapt their lifestyles to reduce breathlessness – but keeping as fit as possible is important for long-term prognosis.
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
- COPD prevalence is approximately 2.6 % of the registered population (9,270 people). Our prevalence puts us beyond the 93rd percentile in England (QOF, 2012). This is higher than the regional average of 2.0%.
- The Association of Public Health Observatories predicts that there are 9130 people in Wakefield CCG living with moderate to very severe COPD (9302 in the Wakefield Local Authority Area). There will also be a large number, potentially in the 1000’s, living with mild COPD unaware of the diagnosis.
- Levels of COPD appear to be higher on the east of the district, rather than by priority neighbourhoods (HEA, 2010). Castleford and Wakefield Central show high standardised rates of COPD.
What’s the trend and what can we predict?
- COPD prevalence has risen slowly over the last few years (QOF 2012).
- The rate per 100,000 people dying from chronic bronchitis and emphysema has reduced and resumed a downwards trend after recent increases in female mortality in 2008.
- The predicted prevalence of COPD (both diagnosed and undiagnosed) in those aged over 16 in NHS Wakefield is modelled to rise to 5.4% by 2020, an increase of 2,087 cases (COPD Dashboard YHPHO, 2011)
What are we doing and what can be done differently?
In July 2011 the National outcomes framework for COPD and Asthma was published. The document sets 5 key objectives for COPD which will be used to map current activity and future priorities.
Objective 1: To improve the respiratory health and well-being of all communities and minimise inequalities between communities.
For the future there must be a greater emphasis on working across organisations and with those groups at high risk of developing COPD for example:
- Work with the Stop Smoking service to develop ways of working to address inequity in those with mental health problems
- Work with the LA to raise awareness of issues of poor Air quality and occupational risk factors
Objective 2: To reduce the number of people who develop COPD by ensuring they are aware of the importance of good lung health and well-being, with risk factors understood, avoided or minimised, and proactively address health inequalities.
In NHS WD many of our community teams have undergone training and been provided with resources to use with the public. For example, Health and Well being workers and health trainers have been trained to use Lung age meters and provide information about lung health to the public; Community Pharmacists providing stop smoking services complete lung age screening as part of their initial assessment and refer on to the GP if any problems are identified. For the future there is a need to:
- Work more closely with the LA to develop networks and links with businesses for example the inclusion of lung health as part of the business matters assessment
- Continue to work with primary care colleagues to raise awareness of lung health
- Work with communities to raise awareness of lung health and risks to maintaining lung health
Objective 3: To reduce the number of people with COPD who die prematurely through a proactive approach to early identification, diagnosis and intervention, and proactive care and management at all stages of the disease, with a particular focus on the disadvantaged groups and areas with high prevalence.
NHS Wakefield District has taken a number of steps to address this objective:
- NHSWD and NHS Kirklees guidelines on diagnosis and management were published in 2010.
- The new Primary Medical Service contract contains detailed standards of care for COPD for all GP Practices signing up to the contract
- All Practices have access to a spirometer to complete lung testing.
- Staff in every Practice have completed spirometry training to support accurate diagnosis and there is a Practice Nurse in all Practices with a respiratory qualification or working towards one.
- Every Practice in NHS Wakefield District has access to its own pulse oximeter a vital piece of equipment use to monitor oxygen levels in people with respiratory disease.
- Introduction of a Locally enhanced service for proactive management of COPD in primary care
To fully meet objective 3 for the future we will:
- Work with colleagues across the health and social care economy to ensure that early and accurate diagnosis takes place and disease registers are accurate.
- Work with Health care professionals to increase the use of Self Management Plans/action plans and rescue medication.
- Provide education and written information for patients and their carers in an appropriate form consistently across the health care community.
Objective 4: To enhance quality of life for people with COPD, across all social groups, with a positive, enabling, experience of care and support right through to the end of life.
- NHS Wakefield District commissioned an expansion of the very successful Respiratory Nurse team from Mid Yorkshire Hospitals Trust. The Community Respiratory Service manages respiratory disease in the community supporting people to avoid hospital admission, reduce hospital stay and the need for hospital visits and support those with respiratory disease reaching end of life.
- A COPD Template has been introduced on to GP computer systems to help Practice staff to manage COPD more effectively
- The Community Respiratory Service support other health care professionals, patients and carers to ensure appropriate management for people with COPD reaching the end of their life. Both Wakefield Hospice teams accept patients with COPD into their services.
Further work is planned over the coming year to
- Ensure that best practice for management of COPD is universally adopted in line with guidance being issued from the department of health and NICE.
- Work with Practices to implement a care planning approach for people with Respiratory disease
- Once evaluation has been competed we hope to continue the work with the local hospices.
- Work with colleagues to investigate innovative ways of working to enable patients to access information and support from a number of sources for example the use of targeted medicines usage reviews in community pharmacies
- Work with the Local Authority to ensure that social care staff and those working in care and nursing homes have the knowledge and skills to support their clients with COPD appropriately
Objective 5: To ensure that people with COPD, across all social groups, receive safe and effective care, which minimises progression, enhances recovery and promotes independence.
- Our local GP commissioning group completed an audit of COPD care across the majority of Practices and supported Practices to act on any challenges that they were experiencing
- Pulmonary rehabilitation is a highly effective treatment for people with COPD NHS Wakefield District have worked with Mid Yorkshire Hospital Trust to provide places in the community which are more easily accessible. Transport has been provided to some classes
- There are two patient support groups for those with respiratory disease and their carers. The Breathe easy group in Pontefract and the Wheezers group in Wakefield
- For the future, NHS Wakefield District are working with Community Pharmacies to increase access to appropriate information and advice to help patients manage their condition
- There are plans to work with the British Lung Foundation and with colleagues across the health care community to increase referrals to Pulmonary Rehabilitation and increase completion rate.