Morecambe Bay Respiratory Network

Project overview, including who was involved in the project
The aim was to bring together all of the teams in Morecambe Bay under a common set of objectives and operating model. We then wanted to fund two key areas - an enhanced model of respiratory care in Primary Care teams (with access to monthly multidisciplinary teams (MDTs) with secondary and community teams), alongside a dramatic increase the capacity of our community teams to offer Pulmonary Rehabilitation (PR) and respiratory physiotherapy services. This was to be provided in ways which improve access for our rural neighbourhoods and communities who struggle to access traditional healthcare services.
Project outcomes/impact
We have see a 77% drop in referrals to respiratory outpatient services as our primary care teams now directly access specialist diagnostic tests. Through integrated education programmes and monthly MDTs our primary care teams are now able to review and manage much of what traditionally went to general respiratory outpatient clinics.

We have seen a 307% increase in referrals to PR and 183% increase to respiratory physio, at the same time our referral-to-treatment times have increased. The increase in PR programmes has mainly focussed on more deprived neighbourhoods and rolling programmes move around the area to provide access to different rural populations.

Over the same time period our spend on respiratory medications decrease and staff survey results for our teams are higher than trust averages.

Admissions to hospital for COPD and Asthma are the lowest in the region and the combined admission rates for Asthma, Bronchiectasis, COPD and ILD combined are no longer increasing in line with the background increase in all other medical admissions with statistical significance.
If you were to run the project again, what would you do differently?
I wish we had collected more baseline data on patient experience with which we could now compare. At baseline we had lots of patient consultation to refer to but not in a way which can be compared against now.
Advice you would have for others undertaking the same type of project.
Talk to as many people as you can, without doing large 'engagement workshops' - 1:1 conversations between leaders and individuals is far more illuminating and helps you get to the heart of the matters which get in the way of us doing the best we can for patients. Identifying barriers and working them through is probably the core thing we have focussed on rather than doing 'new' things - it's the age-old idea of making is easier for colleagues to do the right thing first time.

I'd also say that we have spent much more on recruiting nurses and allied health professionals (AHPs) than doctors - much more use to patients!