Patients in Bath and North East Somerset, Swindon and Wiltshire receiving faster and more reliable asthma diagnoses

A new evaluation has found more patients in Bath and North East Somerset, Swindon and Wiltshire (BSW) are receiving faster and more reliable diagnoses of asthma thanks to an ambitious project designed to ensure adoption and spread of proven innovative products.  A system wide project, led by the West of England AHSN, took place between September 2021 and June 2022, to rollout FeNO devices in a mobile model across the region. The project resulted in 1,896 patients receiving a FeNO test.

FeNO testing is part of the Rapid Uptake Products (RUP) programme to increase uptake of NICE approved products.  FeNO devices measure fractional exhaled oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs.  This can be used to aid in the diagnosis of asthma.  It is a quick and easy test that can be carried out by any healthcare professional that has received training. Benefits of FeNO testing include:

  • improved speed and accuracy of diagnosis for patients suspected of having asthma
  • improved patient care and outcomes, reducing the risk of exacerbations and hospital admissions
  • reduction in inappropriate prescribing and referrals to secondary care

Prior to this project, FeNO testing was not available in primary care settings in BSW and therefore wasn’t always easily accessible to patients.  The project aimed to provide access to FeNO testing in every practice in the region, using a mobile model with devices shared between and moving around multiple sites.  Several Primary Care Networks (PCNs) procured additional devices that were used in a fixed hub model to better meet the needs of their patients and hubs are being considered further following the evaluation.  The project evaluation has found 75% of practices are now offering FeNO testing, which has improved access and reduced travel for patients, with over 80% of patients travelling less than 3 miles for an appointment.  Between September 2021 and June 2022, 1,896 patients were reviewed, with 263 receiving a diagnosis of asthma.

The West of England AHSN supported the application for Pathway Transformation Funding to enable the purchase of FeNO devices and mouthpieces, in addition to backfill for local clinical leads to champion the project in their area and provide support to practice staff.  Bath & North East Somerset Enhanced Medical Services (BEMS) led on the co-ordination of resources and transport in their area.  Project management support was provided by the AHSN to monitor the project timeline, collect and analyse data and record risks and issues.  A new pathway and surveys were co-created and regularly reviewed to measure and continuously improve staff and patient experience of the new service.  As part of the AHSN’s regional FeNO Programme, it co-ordinated the delivery of FeNO testing education webinars that were open to healthcare professionals across the West of England to 95 delegates.

“The FeNO project has been hugely successful and highly appreciated by the staff and patients in primary care.  There has been loads of learning on the way supported by truly dedicated and passionate clinicians.”

Louise Abson, GP Partner Widcombe Surgery and BSW ICS Clinical Lead Planned Care

“It has been great to work collaboratively with the Integrated Care Board, BEMS and so many clinicians on this project.  Implementing FeNO testing in over 60 practices has been such an achievement and wouldn’t have been possible without the support and hard work of primary care staff.  The data from this evaluation demonstrates how patients are benefitting from improved access to FeNO testing.”

Charlotte Hallett, Senior Project Manager, West of England AHSN

New evaluation shows FeNO testing project is supporting better asthma diagnosis across Gloucestershire

More patients in Gloucestershire are receiving faster and more reliable diagnoses of asthma thanks to an ambitious project designed to ensure adoption and spread of proven innovative products, according to a new evaluation.  Three Primary Care Networks in the Stroud and Berkeley Vale locality of Gloucestershire took part in a project, led by the West of England AHSN and delivered by Gloucestershire Integrated Care Board (ICB), which supported practitioners from 17 practices to deliver FeNO testing following face to face training and e-learning modules. The project resulted in 272 patients receiving a diagnosis of asthma.

FeNO testing is part of the Rapid Uptake Products (RUP) programme to increase uptake of NICE approved products. FeNO devices measure fractional exhaled oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs. This can be used to aid in the diagnosis of asthma. It is a quick and easy test that can be carried out by any healthcare professional that has received training. Benefits of FeNO testing include:

  • improved speed and accuracy of diagnosis for patients suspected of having asthma
  • improved patient care and outcomes, reducing the risk of exacerbations and hospital admissions
  • reduction in inappropriate prescribing and referrals to secondary care

Prior to this project, FeNO testing was only offered at a hospital-based clinic that ran sporadically over a 5-year period and therefore wasn’t widely available across the county.  This clinic was re-established for 7 months at the start of the project to provide a blueprint for primary care based FeNO testing. The project evaluation has found during these seven months, 18 practitioners attended the clinic for training from a Senior Nurse Practitioner and to receive a FeNO device for their practice. This enabled the transfer of respiratory clinics from the hospital setting into primary care, with 431 patients accessing a FeNO test in their GP practice between October 2021 and June 2022 and 272 patients receiving a diagnosis of asthma. The evaluation also noted provision of FeNO testing at a local level has improved access and reduced travel for patients, with over 75% of patients surveyed travelling less than 6 miles and waiting less than 2 weeks for an appointment.

FeNO testing has since been rolled out at practice level across Gloucestershire to ensure equity of access as part of a system wide Respiratory Diagnostics Local Enhanced Service (LES).

The West of England AHSN supported the application for Pathway Transformation Funding to enable the purchase of FeNO devices, in addition to the use of the hospital-based clinic as a route to delivering training to practice staff. Project management support was provided by the AHSN to monitor the project timeline, collect and analyse data and record risks and issues.  Surveys were co-created and regularly reviewed to measure and continuously improve staff and patient experience of the new service.  As part of the AHSN’s regional FeNO Programme, it co-ordinated the delivery of education webinars that were open to healthcare professionals across the West of England – these were attended by 90 delegates.

“Having previously offered FeNO testing following referral and seen the improvements in accurate diagnosis, patient education and confidence in self-management, we are now able to offer the test without the delays associated with referral, close to the patient in their GP practice with competent health care professionals in a way that is sustainable in the longer term. We achieved the aims of our project and have also been able to roll out the model across the whole ICB”.

Carol Stonham, Senior Nurse Practitioner – Respiratory, Gloucestershire ICB

“It has been great to work with the ICB on this project, who have really championed the use of FeNO testing in primary care.  The data from this evaluation demonstrates how patients are benefitting from easier access to FeNO testing, which will continue thanks to system wide support”.

Charlotte Hallett, Senior Project Manager, West of England AHSN

Read more about FeNO testing with our patient stories and free implementation resources.

Working with BSW CCG to improve diabetes care

The West of England AHSN and Bath, North East Somerset, Swindon and Wiltshire CCG (BSW CCG) are reaching the end of a 12-month project to improve care for patients with type 2 diabetes.

Since the project launched in February 2021, a community of practice has been established with 174 members from 58 practices alongside secondary care staff.  22 practices have made positive changes as a result of the project thus far, with a further 44 practices continuing to implement changes. Interim results show the percentage of BSW patients with type 2 diabetes in the high-risk category has reduced from 33.3% to 28.9%.

Hear more in this short video from Wiltshire GP and BSW CCG Diabetes GP Champion, Dr Julia Hempenstall:

 

The project used an innovative care framework which aims to support those living with type 2 diabetes. Multiple long-term condition frameworks, developed by UCL Partners, are freely available and they help practices manage large numbers of patients with long-term conditions, whilst empowering the primary care workforce and the patients themselves. This ten-minute summary video from UCLPartners outlines the approach and resources available.

BSW CCG chose to adopt this approach, utilising education and training, as part of a multidisciplinary team, with a focus on supporting practices with the greatest treatment gap and in areas of greatest deprivation. A treatment gap is the actual versus the target % of the population whose treatment has been optimised.

The AHSN have provided project management, developed local implementation resources and facilitated workshops and virtual events.

So far:

  • 58 practices have joined the community of practice
  • Seven BSW primary care networks have all their practices either implementing or engaged with the approach
  • 22 practices are implementing the approach with more planning to start in April 2022
  • 33 delegates have attended motivational coaching training

The community of practice aims to connect clinicians across the CCG to improve their confidence in diabetes management and add a sense of belonging following two years of changes to usual work practices due to the pandemic.  With these improved connections, practice resilience, workforce capacity and integrated diabetes care can also flourish.

Brian Leitch, Commissioning Manager at BSW CCG said:

“As commissioner for diabetes, it’s been great watching practices come together on their own terms in the community of practice, to share information and resources and to discuss how to best support their patients”.

An Advanced Nurse Practitioner working on the project said:

“This has streamlined how we work, reduced the burden on the practice through calls as well as helped support patients to become more responsible for their care. We have identified issues and improved staff and patient awareness of diagnosis as well as treatment of diabetes”

Director of Service and System Transformation at the West of England AHSN, Kay Haughton, said:

“The care frameworks have been a fantastic launch pad for us to support primary care colleagues in BSW. They offer a great opportunity to consider redesigning delivery of care, providing those with diabetes, and other long-term conditions, greater autonomy and support in self-management. It has been a privilege to work with our CCG and primary care colleagues to help transform services for people who have diabetes.”

BSW CCG will continue to progress the improvement programme with longer term impact measures reviewed in the next 12 months, including:

  • Reduced number of practice visits
  • Improvement in patient satisfaction
  • Downward trend in numbers of high-risk patients
  • Changes in medication and potential cost savings

The West of England AHSN will continue to support the roll out of long term condition care frameworks through a new blood pressure optimisation programme. The programme aims to prevent heart attacks, strokes, and vascular dementia in patients with hypertension.

Find out more about the West of England’s work to support those with long term conditions by contacting us.

Piloting child-parent screening to detect FH and save lives

In this blog, Rachel Gibbons, Programme Manager, speaks to GP Dr Amy Howarth whose practice in Gloucestershire is participating in the Child-Parent Screening Service Programme. The Child-Parent Screening Programme is currently being piloted, initially for 24 months, across seven AHSN regions, including in the West of England.

The programme aims to identify families with Familial Hypercholesterolaemia (FH) through the use of a simple heel prick test undertaken at a child’s one year immunisation appointment. FH is an inherited condition which can lead to extremely high cholesterol levels. In those children with a reading of >95 percentile, further genetic testing can be undertaken for family members. FH affects 1 in 250 people in the UK, yet over 90% of cases are still undiagnosed.

Without treatment, FH can lead to heart disease at a young age and significantly increases the incidence of fatal or non-fatal heart attacks. Early detection of FH is important as, if started early enough, treatment gives patients the same life expectancy as the general population.

Child-parent screening offers a population wide, low-cost solution to the management of CVD and is currently the best model for FH detection.

Dr Howarth, why was it important to you to be part of this new programme?

I have Familial Hypercholesterolaemia, so when I heard about this project, I was quite keen to get involved.  It’s a really interesting way to potentially increase the diagnosis rate and find more cases.

Apart from those times when there’s a very high cholesterol result, I’m not sure we’re (in primary care) considering FH as often as we could. This programme can help change that.

I was eleven when my dad had a heart attack, in fact it was on my 11th birthday.  He was 39 and he went off to work and then my mum had a phone call from his boss saying they had called an ambulance for him.

He was taken to the BRI in Bristol, made a recovery and came home five days later on Christmas Eve – people had longer inpatient stays for MIs (Myocardial Infarction) then. They said that his cholesterol was very, very high and that my sister and I both ought to have our cholesterol tested.

Mine was 6.8 I think at that time and hers was 8.8 so they made the diagnosis of Familial Hypercholesterolaemia. There was a great deal less in the way of diagnostics at that point, no genetic testing or anything, no lipid clinics that I remember.

My parents were advised that we should follow a low-fat diet. No medication was suggested at that time. It wasn’t until I was 17 that my GP prescribed statins and apart from four or five years off when I was trying to get pregnant, being pregnant and breastfeeding, I’ve been taking them ever since.

So, did you feel was there was much support for you as a patient at that time?  It was obviously a big shock what had happened to your father.

My father is 72 now and he still gets emotional thinking about that time. My mum was told that he might not make it to the next day. It was all touch and go.

They were also worried about me and my sister. And now I’m a parent, I can imagine how hard that was.

I was referred to a lipid clinic in my 20s. I’d been on statins for several years and my GP wanted to check I was on the right treatment, whether we should be doing anything else.

We know a great deal more about FH now and there’s a lot more support available.

My daughter has been tested and will continue to be monitored.

So, it’s still early days for your Practice, but now you have started to screen children, how have you found it?

We’ve been screening for six weeks and we’ve found that it’s been well received. Everyone who has brought children for their immunisations has wanted to take part in this screening.

And it’s been a straightforward procedure once we’ve gotten used to it and we’ve settled into a routine.

What would you like to see for the future for child-parent screening?

I’d love to see the pilot be successful and demonstrate an increase in case detection rates.

And if it then gets rolled out across the country then that would be amazing.

It would mean that as primary care nurses and doctors we’d be much more aware of FH and FH screening generally. If screening happened at everybody’s one year immunisation appointment, it’s bound to raise awareness amongst healthcare professionals.

I think if it was something that happened nationally, then my nurses would be quite pleased they were involved from the outset. It’s quite exciting to be involved in something that might lead to a national change in practice – and ultimately save lives.

It’s good to be able to talk to the parents about FH as well; people don’t always realise, that by identifying FH in their baby we’re potentially helping lots of other family members too.

I think it’s going to make a big difference.

What would you want other GPs to know if they were considering joining the pilot?

I would say “do it!”.  It’s been a good experience so far and it hasn’t taken lots of resources or time.

I’m also keen to know how else we could use the point of care testing machine and whether it’s something that might be a good asset to the practice in the future.

We don’t get all that many opportunities in general practice to be involved in research if you’re not a dedicated research practice, so it’s something exciting and valuable to be involved in.

Get involved

If your GP practice in the West of England and would like to get involved in this programme please contact Rachel Gibbons, Programme Manager – rachel.gibbons10@nhs.net.

Read more about our cardiovascular disease (CVD) programme, including the roll out of Inclisiran.

Working with the learning disability community to produce our new annual health check videos

The West of England Learning Disabilities Collaborative puts people with a learning disability at the centre of everything we do.

The Misfits Theatre Company, based in Bristol, have previously worked with the AHSN to create videos on topics such as the flu vaccine. In our latest video series, commissioned by NHS South West, we have worked with the Misfits to produce a range of videos that encourage greater uptake of annual health checks for those with a learning disability. The videos cover a range of audiences including health professionals working in primary care, with a second playlist focusing on people with a learning disability and those that care for them.

In this joint blog from members of the Misfits Theatre Company and Rosy Copping, Project Support Officer for the West of England Learning Disabilities Collaborative, we talk about how the video project came to fruition and what it was like to get involved in the filming.

The AHSN perspective from Rosy

Co-creation is the most important factor in our work at the West of England Learning Disabilities Collaborative. It is essential that we gain an insight into the lives of people with a learning disability and their carers, so that we can ensure the needs, concerns and views of the community is reflected through our work.

The video series was created to educate health professionals, carers and people living with learning disabilities on the importance of annual health checks. Annual health checks are so important for people living with learning disabilities as it can help alert them, their carers and their doctors to any underlying medical conditions, and to help manage any current medical conditions that the individual may also be living with, such as epilepsy or diabetes.

We have worked with many experts by experience to produce these videos, namely, the Misfits Theatre Company, Andrew Bright, Head of Development at Thera Trust and Ian Harper, Service Quality Director at Aspire Living. Without their help, the videos may not have spoken to people with learning disabilities in the same way and we might not have been communicating effectively how important it is to get an annual health check. We think it’s vital that when we produce resources, we ensure people from the community who will be using them, get to shape their creation and be directly involved.

We worked with Ian and Andrew on the development of the scripts, and they helped us to ensure that the wording was appropriate for people with learning disabilities to understand, and that the style and tone was friendly and informative. For example, Ian suggested that we change the phrasing of epilepsy to read “seizures”. We then worked with Misfits Theatre Company to film the videos. The Misfits added their own flair to the videos, and we hope they will inspire many others living with learning disabilities to get their annual health checks.

We very much enjoyed working with the Misfits, Andrew and Ian for this piece of work, and we hope that their depictions of why annual health checks are so important, resonate with viewers as much as they did with us.  We certainly could not have achieved this work without their help, so we’d like to say a big thank you!

The Misfits Theatre Company Perspective from Sara Melton

It was fantastic to be part of this very important project.  It is so vital that people with learning disabilities are aware of the importance of having their annual health check and what’s involved in the process.

We asked the actors working on the project to tell us what it meant to them. Here’s what they said:

Rob “I always enjoy helping create different accessible information about the importance of health care.  The fact that the people are willing to get the information out there is wonderful.  I felt the filming went smoothly.  I always have fun doing filming”. 

Beth “It was nice to be involved in the project and feel like I can make a difference by getting the important messages across.  The day was exciting.  I loved using my skills and abilities to educate and inform others”.

Bill “It was brilliant to be involved and I loved being on location filming.  It is so important for people like me to get an annual health check.  The filming went smoothly, and I really enjoyed myself.  The people we worked with were really friendly, which always helps”. 

Penny “The annual health check film went really well.  It helps people with learning disabilities to get their health check.  I really enjoyed being involved in the project.  The film is informative for people like me.  It is rewarding to know I have made a difference for other people with learning disabilities.  I always have fun being involved in films!”

As you can tell from our actors’ comments they really enjoyed being involved in the project.  It is of utmost importance for them to be able to educate others who also have learning disabilities, as well as health care professionals.  Their first-hand experience really enables them to connect and relate with their audience.  The filming also gives them a platform to educate professionals who will be working with people with learning disabilities like them.

We look forward to the next film project!

To find out more about the West of England Learning Disabilities Collaborative, including signing-up to receive newsletters, please visit the collaborative’s webpage.

Spotlight on Inclisiran

October was National Cholesterol Month, and our team have been busy hosting a series of lipid optimisation education sessions; launching the new Child Parent Screening pilot for Familial Hypercholesterolaemia; increasing adoption and spread of lipid optimisation pathways and preparing to roll out Inclisiran to complement current treatments. Read more about our Familial Hypercholesterolaemia (FH) and Lipid Optimisation programme.

In this blog, Clare Evans, Deputy Director of Service and System Transformation at the West of England AHSN, tells us more about Inclisiran and how local systems can get involved….

If you listen to the radio or read a newspaper it won’t be long before you hear the word ‘Cholesterol’. In my experience as a former nurse cholesterol can be seen as something only some of us have but we all have a level of cholesterol in our bodies. The question is whether each of our levels of cholesterol is ‘good’ or whether it’s high and could be doing us harm and lead to cardiovascular disease (CVD).

CVD is a health equity issue

CVD has been identified in the NHS Long Term Plan as the biggest single area where the NHS can save lives in the next ten years – 150,000 to be exact. Heart disease causes one in four deaths in England, and two in five people in England are thought to have high cholesterol. These stats make sobering reading. We also know that those living in areas of multiple deprivation are more likely to be affected by CVD. If we’re serious about tackling health inequity, CVD and cholesterol is one of the most significant areas to focus on.

Through the AHSN Network’s Lipid Optimisation and Familial Hypercholesterolemia (FH) programme we have been making significant progress in the West of England region. The programme includes working across our region’s three systems to increase the diagnosis and treatment of FH patients, including young people and children. Some of us may be pre-disposed to CVD because of FH – an inherited condition passed down in families. FH can lead to extremely high cholesterol levels. It affects 1 in 250 people in the UK, yet over 90% of cases are still undiagnosed. Our new pilot, also taking place across six other AHSN regions in England, will use a heel-prick test to identify FH in children and subsequently their families.

So where does Inclisiran come in?

Before now if a patient was on the maximum dosage of statins, had been prescribed Rapid Uptake Products such as ezetimibe or PCSK9i and their cholesterol levels were not decreasing, options were limited. But now Inclisiran can support these patients.

Inclisiran injections use a biological process where molecules can shut down protein translation to help the liver remove harmful low density lipoprotein cholesterol (which are often simply referred to as ‘bad cholesterol’) from the blood. Inclisiran can be used with statins or on its own.

In line with NICE guidance, Inclisiran won’t be available to all patients with high cholesterol and can only be prescribed if someone has had a CVD event such as a heart attack or stroke. Inclisiran provides a new option when other treatments are not working – it can reduce cholesterol levels by 50%.

Read more about Inclisiran and the partnership between the NHS and industry to tackle cardiovascular disease.

What’s next?

The Accelerated Access Collaborative are responsible for the implementation of the Inclisiran partnership. Now that Inclisiran is available to NHS patients in England, AHSNs, as the delivery partner, are working to ensure that the new treatment fits seamlessly within the lipids care pathway.

Locally we’ve therefore started conversations to discuss Inclisiran and how it complements the current lipid-optimisation pathway for a specific subset of patients. It’s our job at the AHSN to hear about any local barriers or challenges to Inclisiran uptake and work collaboratively with systems to try and remove these.

Inclisiran remains one part of the lipid optimisation pathway, so we’ll be complementing our ongoing programme, so all of those with CVD see benefits rather than ‘just’ those who will be able to receive Inclisiran.

We’re also working to ensure our systems are fully briefed on the Accelerated Access Collaborative’s revised lipid pathway (which is currently being developed).

How do I get involved?

If your work is related to CVD and lipids optimisation in the West of England region whether that be as an Integrated Care System lead, in a Trust, Primary Care Network, General Practice, pharmacy or as a local lipid specialist, please get in touch with me, clare.evans14@nhs.net or my colleague Rachel Gibbons, rachel.gibbons10@nhs.net so we can discuss how Inclisiran can be adopted by your organisation.

Read more about our Familial Hypercholesterolaemia (FH) and Lipid Optimisation programme.

In addition, there is a comprehensive cholesterol awareness and education campaign targeted at health care professionals involved in lipids management which can be accessed on the Heart UK website.

New e-learning module to support detection of early deterioration of patients with COVID-19

The West of England Academic Health Science Network has worked in partnership with other NHS organisations, Health Education England e-Learning for Healthcare (HEE e-LfH), the Wessex Local Medical Committee and the TEL programme simulation and immersive technology team, to develop two free e-learning resources to support detection of early deterioration of patients with COVID-19.

The new COVID Oximetry @home and COVID Virtual Wards e-learning modules – launched in May 2021 –  aim to support the detection of early deterioration of patients with COVID-19 in primary and community care settings.

The e-learning provides an overview of pulse oximetry for patients and carers and explains how to monitor oxygen levels at home or in a care home setting.

People at high risk of becoming seriously unwell from COVID-19 are being provided with a pulse oximeter to monitor the oxygen levels in their blood at home for up to 14 days. This includes people who are clinically extremely vulnerable to COVID-19 and people living in care homes.

A pulse oximeter is a small medical device that is put on the tip of the finger. By regularly monitoring oxygen levels it can be easier to spot if COVID-19 symptoms are getting worse and whether people need treatment or support. People with COVID-19 may become very unwell if their oxygen levels fall too far.

The West of England AHSN is supporting the continued roll-out of ‘COVID Oximetry @home’  and ‘COVID virtual wards’ in our region. Our local support offer makes use of our existing expertise, infrastructure and resources.

Click here to find more information about COVID Oximetry @home and COVID virtual wards, including links to relevant resources and webinars.

Dr Alison Tavaré. Clinical Lead NHS@Home South West and West of England AHSN Primary Care Clinical Lead said:

“Many people with COVID-19 were living in residential homes and we realised that carers were being asked to monitor patients with little opportunity to have had any training; therefore this e-learning was co-developed by carers and clinicians. The aim is to provide a quick overview of COVID-19, how to use a pulse oximeter and most importantly give clear information on what to look out for and who to call if a carer is worried”.

This e-learning provides an overview of pulse oximetry for carers, including how to take the measurements and how to tell others if they are worried. It is designed to be used alongside the NHS pulse oximetry guidance.

More information, including access details, is available on the programme page.

By mid-May 2021, over 2000 patients had been supported through COVID Oximetry @ home and virtual ward models in the West of England. Read more about this collaborative programme, including the patient’s journey, here. 

Remote monitoring scheme reaches all eligible patients in England

With support from England’s 15 Patient Safety Collaboratives including here in the West of England, patients at risk from COVID-19 now have access to a national programme designed to provide an early-warning system if their condition worsens.

During the pandemic, reduced oxygen saturation levels have been shown to be a key identifier of deterioration in patients with confirmed or suspected COVID-19. COVID Oximetry @home uses pulse oximeters for patients to safely self-monitor their condition at home, providing an opportunity to detect a decline in their condition that might require hospital review and admission.

The programme is managed by NHS England and NHS Improvement, in partnership with NHSX and NHS Digital.

From a starting point of 20% of Clinical Commissioning Groups in November 2020, 100% of CCGs had established a fully operational COVID Oximetry @home pathway by early February.

By mid-February 2021, over 1,600 patients had been supported through COVID Oximetry @ home and virtual ward models in the West of England. Read more about this collaborative programme, including the patient’s journey, here. 

Patient Safety Collaboratives (hosted by Academic Health Science Networks) supported this rapid spread by working closely with CCGs in their region to offer quality improvement expertise, access to training and resources, data collection and evaluation, and by facilitating a national learning network.

The COVID virtual ward model is a secondary-care-led initiative, using remote pulse oximetry monitoring to support early and safe discharge from hospital (step-down care) for COVID patients. 94% of acute trusts now have access to a COVID virtual ward, an increase of 69% since the beginning of the year.

Natasha Swinscoe, national patient safety lead for the AHSN Network and Chief Executive Officer of the West of England AHSN, said:

‘We have learned so much during this pandemic, and this impressive uptake in the use of pulse oximetry has undoubtedly saved lives. It has also allowed us to ensure, where appropriate, we can provide safe care for vulnerable people shielding at home through simple, remote monitoring.

‘I’m proud of the role Patient Safety Collaboratives have taken, providing support and assistance ‘on the ground’ to establish completely new ways of working in such a short space of time.’

This intensive PSC support to implement these pathways is due to wind down at the end of March 2021, with AHSNs continuing to support systems to embed @home models in the long-term.

Find out more about how we’re supporting our systems with COVID Oximetry @home and virtual wards. 

A year on since the start of the pandemic, Consultant Acute Physician, Matt Inada Kim, reflects on the simple device (a pulse oximeter) that has been a lifeline for thousands of COVID patients & transformed the way the NHS delivers care.

Read Matt’s blog here.

Working collaboratively to improve patient safety during COVID-19

Since mid-November, the West of England AHSN has been supporting our three STP systems with the rapid implementation of the COVID Oximetry @home service (a step up pathway) to help detect the early signs of deterioration in patients with confirmed or suspected COVID-19. More recently, since mid-January, COVID Virtual Wards (‘step-down’ pathways to help enable people in hospital with COVID-related illness to return home safely as soon as possible) are also being rolled out across the region.

By working collaboratively, over 2000 patients (figure updated May 2021) have now been supported by these programmes across the region.

Both of the pathways feature enhanced monitoring for patients with a confirmed COVID case – pulse oximeters are used by the patient to identify ‘silent hypoxia’ (a reduction in oxygen levels in the blood with no other obvious clinical signs). These services built on learning from the first wave of the COVID-19 pandemic and make use of clear escalation pathways based on the person’s oxygen saturation levels in the blood (which are known as sats).

The West of England AHSN has provided a supportive role to our three STP systems, helping drive collaboration within, and across, each region with over 1500 patients having been supported across the step up service (COVID Oximetry @home) and over 100 patients on the step down service (COVID Virtual Ward) thus far.

Crucially for patient safety, these services were demonstrated to reduce mortality, reduce inappropriate hospital admissions (findings also suggest monitoring sats allows patients to be admitted to hospital before they have severely deteriorated), reduce the length of hospital admissions and escalation to intensive care wards.

Both COVID pathways have been fast-paced implementations of new services, largely from a standing start, with most systems in our region rapidly launching the pathways within a few weeks of the publication of national guidance from NHS England.

Hein Le Roux, Joint Clinical Lead for Gloucestershire CO@H, also Clinical Lead West of England AHSN, and GP at Churchdown, said:

“The COVID Oximetry @Home service has had a real impact on my patients who have developed COVID. In Gloucestershire, over 1100 patients have been referred to the service and for the majority it has provided reassurance that they have not developed the potentially fatal silent hypoxia. For the few people who did deteriorate, we were able to identify them early and prioritise their care with steroids and oxygen in the hospital setting.

This has meant they were less unwell prior to receiving treatment and have thus recovered more quickly. It has also shown that by working together as a care system between primary care, the COVID Oximetry @Home service, South Western Ambulance Service NHS Foundation Trust and our acute colleagues, we have improved patient care”.

Michelle Reader, Chief Operating Officer from Medvivo said:

“The Medvivo-provided oximetry monitoring services are a testament to the collaborative and system-wide approach that was taken across BaNES, Swindon and Wiltshire (BSW). Once we’d offered to provide the service for the region we felt really supported by colleagues in commissioning, primary care, secondary care, community services and the AHSN. This allowed these services to be established very quickly, enabling us to provide valuable supportive services to the people of BSW.

The sharing of learning from other areas was really important. I’ve never been part of such a rapid system-wide collaboration, and there was a real ‘can do attitude’ from all involved. It’s been a learning process and we continue to learn and develop the service. The feedback from the patients has been fantastic – this makes all the efforts worthwhile.”

To find out more about COVID Oximetry @home and COVID Virtual Wards, including implementation packs and recorded webinars, please visit our dedicated COVID-19 webpages.

The below case study demonstrates the impact of the COVID Oximetry @home pathway through the story of one patient who we will call John*:

  • Day 1 – John is a 57 year old gentlemen who has developed cough and fever.
  • Day 2 – John takes a COVID test
  • Day 3 – John receives a positive COVID test result. John’s GP contacts him and he is placed in ‘at risk group’ for silent hypoxia & deterioration. John is referred to the COVID Oximetry @Home (step up care pathway) and provided with pulse oximeter.
  • Day 4 – John receives advice on how to use the service for daily monitoring of blood oxygen saturations through a digital monitoring platform. John’s sats are recorded at 95%.
  • Day 7 – John’s sats are now 91% (this is now in the parameter of silent hypoxia). John is contacted by the service provider where he advises he is feeling ‘okay’. John’s advised to call 999 urgently for hospital assessment and possible treatment.
  • Day 7 to 10 – John is admitted to hospital and given dexamethasone and oxygen. John’s sats gradually improve over the next three days.
  • Day 10 – John is discharged home after four days in hospital. John is now monitored on the COVID Virtual Ward (step down pathway).
  • Day 13 – John has made steady progress and is discharged from the COVID Virtual Ward service and sign posted to Long-COVID pathway & given safety netting information.

Without the COVID Oximetry @home service and use of a pulse oximeter, John may not have known he was significantly unwell and could have required more extensive hospital treatment, or potentially even died. These services have not only a positive impact for the patient but the positive impacts are seen across primary and secondary care.

*John is not the patient’s real name.

Quality improvement for primary care workshops launch

The West of England Academy are hosting a new series of five free-to-attend interactive online workshops each Friday from 16 April.

Attendees will gain a basic understanding and practical knowledge of applying Quality Improvement (QI) techniques to real-world challenges in primary care.

Modelled on our hugely successful QI Summer and Winter Series, this five-week course, held over 90-minutes each Friday from 12noon can be joined as single sessions or a series.

The workshops have been developed, and will be delivered by, the West of England Academy team alongside guest speakers. Topics include stakeholder mapping, process mapping, data management and the basics for change management.

Attendees can be in any role and/or grade within their organisation, for example from clinical, administration or facilities.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

Find out more about QI for primary care and book here. 

The West of England Academy offers a wide range of free resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email weahsn.academy@nhs.net.