The BMJ Awards 2017: Primary Care

Respiratory quality local improvement scheme

Asthma and chronic obstructive pulmonary disease (COPD) are problems everywhere, but are particularly acute in Birmingham, says local GP Raj Ramachandram. He is clinical lead for an ambitious plan by Birmingham South Central Clinical Commissioning Group (CCG) to manage these patients better in primary care and reduce high levels of emergency hospital admissions.

“Most people went straight to the emergency department, and emergency admissions were very high in this group of patients,” he says. “While the Quality and Outcomes Framework (QOF) had done something to raise the issue in primary care, QOF is mostly about process rather than outcomes. We wanted to improve outcomes as well as save money.”

The scheme required the 55 practices involved to implement 17 interventions, 10 for managing COPD and seven for asthma. A mandatory training programme required every practice to send one doctor and one nurse to annual respiratory workshops, and clinical templates were provided, based on national standards.

“It took a while to achieve savings, but we kept going and the CCG supported us,” he says. Four years after the scheme began in 2011, 41 practices achieved 80% of the targets set, and the cost of the programme (£485 000 a year) was outweighed by reductions in admissions, saving the CCG almost £400 000 a year. Far more patients now have self management plans, and follow-up of patients with COPD after discharge has been greatly improved. “The headlines may be about money saved, but better patient care is just as important,” he says. The success of the scheme has been recognised by the local sustainability and transformation plan, which wants to adopt it more widely.

Domestic abuse screen in general practice

Despite the high incidence of domestic abuse and violence, few GPs know how …