People living with respiratory conditions in Gloucestershire can now access more care closer to home than ever before, from diagnostic tests in community settings to group support sessions where they can share experiences with peers.

More than 60,000 residents in the county are known to be living with conditions such as asthma, chronic obstructive pulmonary disease (COPD), and other illnesses which affect breathing.

The NHS in Gloucestershire’s Integrated Respiratory Team brings together experts from across the NHS and voluntary sector to ensure every patient diagnosed with a respiratory condition benefits from personalised care suited to their needs in the towns and villages where they live. This can include specialist consultant clinics in community settings, group sessions for peer support, and access to respiratory champions who offer help and advice.

This means fewer patients need to travel to the county’s main hospitals in Gloucester and Cheltenham, and primary care (GP surgery) staff across Gloucestershire are empowered to work together, sharing skills, knowledge, and learning. This, in turn, helps clinicians in primary care to spot and diagnose issues faster, giving people the chance to manage conditions while they are mild and preventing respiratory crises.

Diagnosis in the Community

One of the biggest benefits of the Gloucestershire approach is bringing diagnostic tests to the patients who need them, rather than requiring patients to travel to hospital settings.

Spirometry, or lung function tests, are vital for identifying the causes of symptoms related to lung conditions, including breathlessness. Along with FeNO (fractional exhaled nitric oxide) tests, these can now be carried out at GP surgeries across the county.

Staff benefit from the support of experts, including Carol Stonham, NHS Gloucestershire’s Clinical Nurse Advisor for respiratory, to learn diagnostic skills and stay up to date with new methods and techniques. Carol said:

“People are now being diagnosed more quickly and receiving an accurate diagnosis. This means we are also seeing a reduction in patients being unwell and exacerbating their conditions, and an increase in people accessing not just the most appropriate medication but also non-prescribable treatments. That includes options like pulmonary rehabilitation, singing for breathing, and exercise-based activities.”

Consultant Roadshows

Giving those with respiratory conditions access to specialist care in their own community is one of the team’s aims.

Charlie Sharp, consultant in respiratory medicine at Gloucestershire Hospitals NHS Foundation Trust, works closely with nurses and GPs in Primary Care and regularly takes his expertise out to surgeries. Charlie said:

“It gives nurses and teams the chance to discuss tricky cases and to share best practice and treatment options. Sharing knowledge and training across the county means the teams in Primary Care remain skilled and supports better management of patients in the community.

“Why tell people they are going to hospital, that they need to wait months to come and see me, when we can go and see them and visit different places around the county? Even in Gloucester and Cheltenham, it is not always easy for people to get to the main hospitals. If they are going to their GP practice, it is closer to home, the parking is often easier, and it takes up less time in their day.”

Sharing specialist knowledge in regular online calls, the team can stay up to date and share experiences, meaning staff in Primary Care are better equipped to spot the cases which need referral to secondary care and support those who can be treated in their communities.

Respiratory Champions

With different needs in different communities across Gloucestershire, the Integrated Respiratory model places experts or Respiratory Champions into each Primary Care Network (group of GP surgeries working with community and other health and care services). The champions support patients living with long-term respiratory conditions and empower them to self-manage and stay well.

Frances Ainsworth-Parker is one of Gloucestershire’s Respiratory Champions. She runs a COPD Education Programme across the Cheltenham Peripheral PCN, which covers Cheltenham, Bishop’s Cleeve, and Winchcombe. It involves inviting those with moderate COPD to attend a one-hour session every week for four weeks. She said:

“I describe it as like an antenatal group but for COPD. Everyone learns together and, at the end of the course, many of them stay in touch to support each other and attend exercise classes together.

“People feel more in control of their breathlessness and gain tools to help them manage their condition. They understand their condition better and how they can manage it, such as knowing how COPD can worsen with exacerbations and how to prevent those. Simple measures such as wrapping up during cold weather and staying home, where possible, when it’s really cold, staying physically active, hydrating, eating well, and getting vaccinated can all help people stay well with COPD.”

Groups like those run by Frances play a key role in keeping people with respiratory conditions healthier at home, reducing the risk of exacerbations and infections which can permanently affect lung function.

Acute Respiratory Infection Hubs

Chest infections and flare-ups are among the biggest reasons for emergency department (ED) attendances nationally, but only 25% of people attending ED for those conditions are admitted. This means a community treatment option can be a better alternative for patients. Gloucestershire is now putting this alternative into action, with Specialist Respiratory Teams in our main hospitals working seamlessly with colleagues in Primary Care, allowing patients to receive appropriate care in a community setting.

More than 14,000 appointments have been provided at Gloucestershire’s Acute Respiratory Infection (ARI) Hubs, which offer same-day appointments with specialists and some treatments for conditions which would previously have been treated in hospital. The Hubs at Rosebank GP Practice in Gloucester and St Paul’s Medical Centre in Cheltenham have already proved successful, with more than a quarter of patients saying they would otherwise have attended ED with their symptoms.

Once treated by an ARI Hub, patients can also be referred back to their GP surgery respiratory champions for ongoing care and support in managing their conditions.

Community Support and the Patient Voice

Pauline Masters is the Gloucestershire patient representative on the NHS Gloucestershire respiratory clinical programme group, with lived experience of respiratory conditions and how they are treated in the county. She believes the integrated approach is making a difference. She said:

“Neighbourhood health is a good idea. Most of the management of respiratory conditions is done at Primary Care and community level, and what we need is that local support all the way along our patient journeys.”

Pauline’s role now extends to running a Breathe-Easy group in the community, which is open to anyone with a respiratory condition. The informal meetings include a talk from an expert on topics including pulmonary rehabilitation, how to stay well in winter, followed by a space to chat, share stories, and access peer support. She said:

“Having a respiratory condition can often be isolating, and with the group we can guide people and educate them about the services on offer.”

Notes

  • If you have a chronic lung condition and have been invited for a flu jab there’s still time to take up the offer. Having the flu vaccine helps reduce serious illness and protects vulnerable groups including those with respiratory conditions like COPD. This means fewer people need care in hospital. Every jab makes a difference in keeping Gloucestershire healthy this winter.
  • Smoking can have a significant impact on lung and respiratory conditions. Current smokers across Gloucestershire can access dedicated personalised support to stop smoking from our Healthy Lifestyles Service.
  • Gloucester Asthma + Lung UK (A+LUK) Support Group meets on the second Wednesday of every month, 2pm to 4pm at the Cooke Room in St Mary de Crypt Church, Southgate Street, Gloucester. For more information call 0300 222 5800 or email supportgroups@asthmaandlung.org.uk.