Dr Karen Sennett highlights key learning points for primary care from the updated NICE guideline on chronic obstructive pulmonary disease (COPD)

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Read the related Guidelines summary

Implementation actions for STPs and ICSs

written by Dr David Jenner, GP, Cullompton, Devon

The following implementation actions are designed to support STPs and ICSs with the challenges involved with implementing new guidance at a system level. Our aim is to help you consider how to deliver improvements to healthcare within the available resources.

  • Ensure local formularies and care pathways are reviewed and adapted to match NG115
  • Commission sufficient pulmonary rehabilitation services to allow prompt referral of all appropriate patients, especially those with MRC 3 or above (as now required for the QOF)
  • Encourage practices and Primary Care Networks to develop practice- or network-based COPD management plans
  • Collaborate with local public health colleagues to ensure smoking cessation services are widely available and locally accessible
  • Establish local training programmes for spirometry testing and interpretation to meet new quality control standards.

STP=sustainability and transformation partnership; ICS=integrated care system; MRC=Medical Research Council dyspnoea scale; QOF=quality and outcomes framework; COPD=chronic obstructive pulmonary disease

Implementation actions for clinical pharmacists in general practice

written by Gupinder Syan, Training and Clinical Outcomes Manager, Soar Beyond Ltd

The following implementation actions are designed to support clinical pharmacists in general practice with implementing the guidance at a practice level.

  • Agree scope:
    • create searches to identify the COPD patient population
    • consider your role when managing patients with COPD within your scope of practice, e.g. annual medication reviews to review inhalers and formulate a self-management plan (such as those on LABA + LAMA who may benefit from triple therapy)
  • Discuss and determine how your skillset and scope fits within current COPD management in the practice, so that you can add value without duplicating work. You may need to attend training to be able to carry out things like vaccinations and spirometry
  • Prepare by ensuring you have the necessary understanding to carry out reviews, including knowledge of:
    • signs and symptoms suggestive of COPD
    • relevant guidance and any investigations required, including the five fundamentals of COPD care (as per NICE Guideline 115)
    • performing and interpreting spirometry, with training if needed, if there is a local need
    • administration of pneumococcal and influenza vaccines, with training if needed
    • available inhaler technique training devices and inhaler placebos to support effective inhaler technique counselling and adherence
    • holistic management of COPD, including managing co-morbidities, lifestyle advice, and relevant organisations to signpost to
    • appropriate use of rescue packs for flares
    • referral criteria and pathways to access COPD specialist nurses, pulmonary rehabilitation, smoking cessation services, spirometry, chest X-ray, and secondary care (where appropriate)
    • patient information leaflets that people may find useful
  • Deliver reviews:
    • focus on co-developing a personalised self-management plan to improve the quality of these while individualising treatment and lifestyle advice
    • provide practical advice on breathlessness and what to do if the patient’s condition deteriorates
  • Evaluate outcomes to assess how you added value or improved clinical outcomes (e.g. by the proportion of patients with a current personalised self-management plan).

COPD=chronic obstructive pulmonary disease; LABA=long-acting beta2 -agonist; LAMA=long-acting muscarinic antagonist

References

  1. NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE Guideline 115. NICE, 2018 (updated July 2019). Available at: www.nice.org.uk/ng115
  2. NICE. Clinical Knowledge Summary. Chronic obstructive pulmonary disease. NICE, last revised March 2019. cks.nice.org.uk/chronic-obstructive-pulmonary-disease#!topicSummary (accessed 16 August 2019).
  3. NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Tools and resources. Summary versions. Visual summary: treatment algorithm. NICE Guideline 115. NICE, 2018 (updated July 2019). Available at: www.nice.org.uk/guidance/ng115/resources
  4. General Medical Council. Good practice in prescribing and managing medicines and devices. GMC, 2013. Available at: www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/prescribing-and-managing-medicines-and-devices
  5. British Lung Foundation website. COPD (chronic obstructive pulmonary disease). www.blf.org.uk/support-for-you/copd (accessed 6 August 2019).
  6. NICE. Stop smoking interventions and services. NICE Guideline 92. NICE, 2018. Available at: www.nice.org.uk/ng92
  7. NICE. Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing. NICE Guideline 114. NICE, 2018 (updated June 2019). Available at: www.nice.org.uk/ng114
  8. British Lung Foundation website. Bronchiectasis. What is it? www.blf.org.uk/support-for-you/bronchiectasis/what-is-it (accessed 12 September 2019).
  9. NICE. Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing. NICE Guideline 117. NICE, 2018. Available at: www.nice.org.uk/ng117
  10. National Centre for Smoking Cessation and Training (NCSCT). NCSCT online training. elearning.ncsct.co.uk (accessed 15 August 2019).