Introduction Coventry had high admissions rates for COPD, and poor co-ordination between primary and secondary care. There was generally low interest in COPD and poor attendance at educational meetings. An audit revealed that 74% of individuals with COPD admitted to hospital made contact with their practise in the month before admissions and 58% had received 3 or more courses of antibiotics in the year prior to admission, indicating the potential to improve care quality and reduce costs.

Methods We reviewed current provision against NICE standards and the emerging National COPD Strategy, identified gaps and agreed priorities. In parallel a patient and carer consultation was undertaken using focus groups, interviews and questionnaires. This information was used to formulate a model that integrated primary and secondary care and shared clinical pathways. Key was the establishment of a consultant led community based COPD team.

To allow individual practises to benchmark themselves against NICE standards and then support them to develop their own improvement plans, a COPD management tool (POINTS) was introduced into most practises.

Financial incentives (QP 8 and QP 11) were used to drive key elements, in particular improved recording of exacerbations, the use of rescue packs and self-management plans. Education for Primary Care Nurses was made “user-friendly” and delivered as monthly ‘bite size’ education sessions, with GP reimbursement for nurse time.

Results There has been a high level of support and engagement from primary and secondary care. COPD is now the top local LTC priority. During the first year admissions and re-admissions have reduced by approximately 15%. More than 90% of COPD outpatient activity is now in the community (including post discharge follow up).

Patient surveys have shown very high levels of satisfaction.

The project has been cost neutral in its first year (including savings from Oxygen Register cleansing but excluding savings from moving outpatient care to the community team) and the CCGs project savings of approximately £300,000 and £600,000 at 24 and 36 months.

Discussion This demonstrates that service redesign can deliver rapid improvements in the quality of care with significant cost savings potential.