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Best respiratory initiative of the year


• COPD integrated care project, EsyDoc Pathfinder Consortium

• Commissioning for breathlessness, ALPF Health Consortium

• Dudley COPD local enhanced service, Dudley Respiratory Group


Winner – Dudley COPD local enhanced service, Dudley Respiratory Group


The judges were impressed by the well-documented results for the Dudley COPD local enhanced service (LES).

The scheme achieved savings of almost £900,000 and a strong positive impact on patient experiences and outcomes.

In the UK, approximately 900,000 people are diagnosed with COPD – and in Dudley almost 5,000 patients are listed on COPD registers.

Each hospital admission for COPD costs £2,200. The driving force behind the LES was the desire to reduce avoidable hospital admissions.

This goal was reached by developing integrated, patient-focused services providing efficient, high-quality, evidence-based care, and by offering care close to home co-ordinated by general practice.

 It also aimed to:

• bring equity of care to all patients with COPD across Dudley

• encourage self-management through individual self-management plans and rescue medication for exacerbations

• develop a seamless service across primary and secondary care

• engage and enthuse colleagues in primary care.

• ensure that treatment guidelines were followed by all healthcare professionals across Dudley.

The scheme

All 63 practices in the area have signed up to the scheme, under which practices nominate a lead for COPD, working towards a COPD diploma or equivalent. To date, some 90 clinicians have completed the diploma.

Practices grade their patients according to NICE guidelines and review the severity of each patient’s COPD with an annual or twice-yearly check.

As well as the COPD grades and annual reviews, practices also develop their own ‘high risk of admission’ registers and assess treatments according to local guidelines.

Other elements of the scheme are to encourage self-management and help patients handle exacerbations themselves using standby antibiotics or steroids.

This scheme has also seen the redesign of oxygen and pulmonary rehabilitation services. Clinicians support and educate patients and other healthcare professionals about COPD, monitor results and offer regular reports to practices.


Cost savings come from a combination of reduced admissions, prescribing efficiencies and appropriate oxygen use. Efficiencies targeted by the LES total nearly £900,000.

Other outcomes emerging from the scheme include:

• prescribing of rescue medication for patients who were discharged from

hospital following an exacerbation

• development of a new oxygen service that sees all patients assessed when they may need oxygen

• a 400% increase in pulmonary rehabilitation referrals

• joint development and use of self-management plans

• integration of care with the local hospital and across community services, and development of a referral pathway between services

• education and support offered to community teams

• patient empowerment, support and appreciation – the scheme reported 100% positive feedback from its patient satisfaction questionnaires.


Judge’s Comments

Excellent programme, with strong participation, widespread reach and well-evidenced impact on patient experience, outcomes and cost efficiencies. Excellent contribution to the evidence base for better outcomes at lower cost. Furthermore, this is achieved in an area with pockets of considerable disadvantage.

Neil Churchill, chief executive, Asthma UK


There are some startling results to be digested here, and impressive savings. The other thing I note is the wide engagement. Well done to this group for their efforts.

Pritpal Tamber, medical director, Map of Medicine