EXECUTIVE SUMMARY

The UK National Health Service (NHS) is developing rapidly. During this time of change there are many resource pressures on the overall healthcare system. There are also drivers being developed which aim to improve the consistency and quality of care for all patients. The British Thoracic Society (BTS) recognises these challenges and is an advocate for high quality standards in respiratory care. This statement has been developed from major evidence-based guidelines by an expert group with wider consultation including primary care colleagues in the General Practice Airways Group. It is aimed at those who commission and quality assure respiratory care as well as those involved in delivering this care.

The BTS recognises that, in many areas, development of integrated care pathways and initiatives to improve care with earlier discharge from hospital, prevention of admission strategies and fast track outpatient clinics are developing with a variety of experiences. These are intended to improve the patient’s experience of care, the quality of care and the effectiveness of the care provided.

We hope that this statement will allow positive collaboration between primary and secondary care—and discussion between clinicians and commissioners. The areas covered pertain to the commonest causes of respiratory admission in the adult population, and are relevant no matter who refers and who manages the care of the patient. We recognise that, at times, individual uncertainties in clinical practice and balanced clinical judgement will result in practice outside the guidance. However, we hope these will be relatively few and for understandable reasons.

Some areas of the statement are aimed at common problems which result in high-cost hospital admission and high health care costs; others are aimed at rarer conditions. It should be remembered that some of the rarer conditions can be a large “hidden” cost to the NHS—all of these are very …