The Royal Primary Care Chesterfield General Practice based Respiratory Virtual Ward Pilot
Project overview, including who was involved in the project
The virtual ward was funded by the the Health Technology Assessment Accelerator Fund, and was operational between June 2024 and May 2025. It served eight of the nine Royal Primary Care Chesterfield GP surgeries, which covers a practice population of approximately 43,500 patients who live in Chesterfield and its surrounding towns.Service Aims:
•Support patients to be managed safely in their own home during an acute respiratory illness
•Reduce unnecessary admissions and contact with emergency and out-of-hour health care services
•Ensure accurate diagnosis of any underlying respiratory disease and optimise its management
•Make a holistic assessment of the patient for any unmet physical health, mental health, or social care need
•Offer education on their respiratory condition and support improved patient self-management.
The community respiratory virtual ward service included:
•A general practitioner (GP) with a specialist interest in Respiratory Medicine
•A Band 5 practice nurse (non-prescriber)
•A trainee GP assistant/healthcare assistant
•A twice monthly virtual community multidisciplinary meeting attended by the virtual ward GP, respiratory consultants from Chesterfield Royal Hospital, community respiratory physiotherapists and both community and hospital based respiratory nurse specialists.
•Out of Hours Cover was provided by DHU healthcare
•Supported by Derby and Derbyshire Integrated Care Board (ICB)
Project outcomes/impact
A total of 198 patients were supported across 227 admissions, with 90% of patients requiring no contact with secondary care services during their virtual ward admission. Only nine patients required hospital admission.The service demonstrated impact in improving long-term disease management. Inhaled medication optimisation occurred in 57 admissions, and 59 patients were commenced on new oral therapies to improve symptom control and reduce exacerbation risk. Notably, 12 patients were able to manage acute exacerbations without the use of oral corticosteroids where these had previously been required.
The holistic assessment approach resulted in the identification of 70 new diagnoses, including significant respiratory conditions such as bronchiectasis, interstitial lung disease and lung cancer, alongside important non-respiratory comorbidities such as hypertension, osteoporosis and heart failure. Of patients who smoked, 80% received documented smoking cessation advice, leading to three quit attempts. Cardiac risk factor optimisation resulted in improved blood pressure control in 38 patients and lipid management optimisation in 7 patients.
Appropriate patients were offered referrals to pulmonary rehabilitation and pulmonary physiotherapy. Multidisciplinary work enabled six patients to commence long-term macrolide therapy in primary care without requiring hospital referrals, improving treatment access and reducing delays.
Patient feedback was overwhelmingly positive, with most respondents reporting increased confidence in self-management and feeling that the service helped prevent emergency care attendance.
Overall, the pilot demonstrated that a primary care-led respiratory virtual ward can safely manage acute illness, improve chronic disease optimisation, reduce hospital admissions and identify unmet health needs within a high-risk population.
If you were to run the project again, what would you do differently?
The pilot shows the value of clinical leadership from a GP with extended skills in respiratory medicine. This enabled a truly holistic approach to managing both acute exacerbations and long-term respiratory health, while also addressing wider physical, mental and social care needs.The project highlighted that virtual wards could act as an important engagement opportunity for patients who do not routinely attend annual respiratory reviews. By proactively addressing unmet needs during an acute episode, the service was able to improve disease understanding, optimise treatment and strengthen self-management skills.
However, the relatively short duration of funding limited the ability to build confidence among patients in using remote monitoring equipment. A longer implementation period would have allowed a better evaluation of long-term outcomes such as admission avoidance and exacerbation reduction.
The pilot also demonstrated the importance of integrated multidisciplinary working. Regular virtual multidisciplinary team (MDT) meetings strengthened relationships between primary care, community respiratory teams and secondary care specialists. This collaborative approach improved clinical decision-making, enabled timely access to specialist treatments and has continued to benefit respiratory patients beyond the pilot period.
Advice you would have for others undertaking the same type of project.
Engagement with secondary care respiratory teams and community services from the outset is essential to ensure safe escalation pathways, shared decision-making and timely access to specialist treatments. Regular MDT meetings can significantly enhance integration and improve patient outcomes.It is also important to recognise that virtual wards provide an opportunity not only to manage acute illness but to address wider long-term health needs. Building structured holistic assessment processes into the pathway can maximise the value of patient contact and improve preventative care.
Adequate training and support for staff in using remote monitoring technology is critical, as is ensuring patients receive clear education and reassurance to build confidence in virtual care models
Virtual ward models may be particularly effective in reducing inequalities and improving engagement within these groups, by encouraging engagement during their acute illness.