Abstract
INTRODUCTION: In the United Kingdom 5% of mortality can be attributed to Chronic Obstructive Pulmonary Disease (COPD). Exacerbations of COPD. exacerbations of COPD account for 10% of acute medical admissions with rates in east London significantly higher than elsewhere in the UK. With an improved evidence base for interventions which can reduce symptoms and prevent exacerbations, attention has turned to the systematic management of COPD across the boundary of primary and secondary care. The nGMS contract provides incentives to develop registers, improve diagnosis using spirometry and record chronic care details. integrating these measures with early hospital discharge schemes, and the effective implementation of guidelines remains a challenge. AIM: To discuss developing a practice based local enhanced service to build practice capacity in COPD. as practice based commissioning develops, the enhanced service will form a stepping stone towards a service model which crosses boundaries between practices and between hospital and primary care. METHOD: Core elements necessary for chronic disease management in COPD are described. These include: 1. The role of a clinical effectiveness unit in providing guidelines, facilitation, data entry templates and audit. 2. A local enhanced service for COPD. 3. A community based spirometry service. 4. A dedicated locality clinical lead. Findings: We will demonstrate the importance for primary care organisations which utilise data analysis techniques which go beyond the quality and outcome framework. This will be demonstrated in relation to: Admission data by practice Linkage to hospital PAS systems for spirometry results Data collection and audit for the COPD enhanced service. DISCUSSION: The limited evidence base for some of the system interventions will be discussed. Some of the barriers to change will be identified, particularly those which affect interventions of proven clinical benefit. Conflict of interest and funding None.