Adults' Services
Respiratory Service
The Respiratory Service is currently offered for adults in Birmingham North, East, Central and West who are diagnosed with one or more condition that causes breathing difficulties.
About our service
The respiratory service is currently offered for adults in Birmingham East and North and Central and West who are diagnosed with one or more condition that causes breathing difficulties. Treatment and advice is provided in clinics and in the community, depending on individual service users’ needs.
The respiratory admission avoidance and assisted discharge service is available for North, East, Central and West Birmingham adult patients aged 35 or over who have a confirmed diagnosis of COPD, chronic asthma , bronchiectasis or ILD.
For Central and West Birmingham primary care, the respiratory clinic is led by a GP with an extended role (GPwER) and is accesible by patients aged 18 years and over, who have a suspected or confirmed diagnosis of COPD, asthma or bronchiectasis.
East and north locality offers a nurse-led COPD clinic, for patients aged 35 and over who have suspected or confirmed diagnosis of COPD.
The pulmonary rehabilitation (PR) programme is offered to adult patients resident within Birmingham and Solihull integrated care system (ICS) aged 35 years and over who have a suspected or confirmed diagnosis of COPD, asthma, bronchiectasis and interstitial lung disease (ILD).
We are currently delivering an early supported discharge pilot in collaboration with University Hospitals Birmingham NHS Foundation Trust (UHB) in the south locality of the city.
We currently do not provide an oxygen service; please refer to secondary care for assessment and ongoing treatment.
Who delivers it?
The service is delivered by a multidisciplinary team (MDT) of nurses, physiotherapists, an assistant practitioner and healthcare support workers based at St. Stephen's Centre, Handsworth.
GPwER clinics are clinics run by GPs with extended roles (previously known as a 'GP with a special interest' or a GPwSI). These are delivered at Sparkbrook Health Centre and Soho Health Centre, while the nurse-led clinics are delivered at Harvey Road Health Centre.
Pulmonary rehabilitation classes
Service referral criteria
Referrals are accepted from:
- Secondary Care A&E and inpatients departments
- General Practitioners
- Patients identified by practice nurses, intermediate care team, community nurses.
Information for carers / family members
- A referral needs to be made by a healthcare professional.
- For initial support, your GP/practice nurse or district nurse should be contacted, if not already known to respiratory nurse.
For professionals
- Referrals are made by emailing BCHNT.bchcrespiratory@nhs.net for AA/AD, GPwER and nurse-led clinic.
- Referring to pulmonary rehabilitation.
- Joint visits may be undertaken with other health care professionals as necessary.
Admission avoidance and assisted discharge
The admission avoidance (AA) and assisted discharge (AD) service provides access for adults with a confirmed respiratory diagnosis.
We aim to deliver active care management when their condition is unstable, delivered within the patient’s home environment by a specialist multidisciplinary team.
The AA and AD service should accept referrals for patients aged 35 years and above with the following conditions:
- chronic obstructive pulmonary disease (COPD)
- bronchiectasis
- chronic asthma
- interstitial lung disease
The key objectives of the service are to:
- provide specialist care to adults of 35 years or over with unstable episodes of the above respiratory conditions, using a multidisciplinary approach
- prevent hospital admissions and reduce the length of hospital stay using both ‘in reach’ and ‘outreach’ strategies
- prevent hospital readmissions within 28 days of discharge
- ensure prompt, optimal management and integrated care for all patients in line with evidence-based guidance, providing:
- expert care in the community when appropriate
- admission to hospital when required
- support early, structured and assisted discharge of patients with COPD, chronic asthma or bronchiectasis when appropriate
- to ensure effective management of comorbidities, optimisation of therapy and smoking cessation as appropriate.
- to support patients within their home to prevent hospital admission or facilitate discharge following a hospital admission
- to minimise the impact of the disease (through faster and more effective treatment of exacerbations and fewer hospital admissions and re-admissions)
- improve symptom control, function and quality of life for all patients with the disease
- ensure effective communication with the patient and support for self-management
- co-ordinate with all disciplines across the care pathway to ensure integration and effective communication with GP services, secondary care providers and social services as appropriate
- provide specialist support, when required, to patients in the end stages of their chronic respiratory condition.
Primary Care Clinics
The GPwER clinic will accept referrals for adult patients where there is suspected and uncertain diagnosis of asthma, COPD and bronchiectasis whereas the nurse-led clinic will accept referrals with suspected and uncertain diagnosis of COPD.
Referral criteria
- Poorly controlled or unstable asthma or COPD
- Frequent exacerbations or intolerance to medications
- Patients complaining of cough or breathlessness with suspected respiratory care
- Assessment to optimise treatment i.e. Long term nebuliser trial.
Exclusion criteria
- Suspected Cancer
- Suspected TB patients
- Haemoptysis
- Acute, abnormal changes on CXR
- Patients already under the care of a respiratory physician
- Patients under age 18 for GPWSi Clinics and under age of 35 for nurse-led clinics.
Diagnostic Direct Spirometry Service (DDS)
The service was commissioned for West Birmingham GPs as a pilot in Sept 2016. Due to high demand from the GP practices, the service has been extended and has continued. The service is currently run every Wednesday on a weekly basis 9am -5pm.
The clinic is set up to perform spirometry/reversibility with Interpretation and includes recommendations to aid the diagnosis of Asthma and COPD.
Referrals are sent via fax to email to BCHNT.bchrespiratory@nhs.net the referral is triaged and, if the criteria are met, the patient will be allocated an appointment.
PRISMM
Our service is also involved in the implementation of the programme for respiratory integration of services in the Midland Metropolitan area (PRISMM). PRISMM provides support through virtual MDTs (GPs, respiratory consultants, community respiratory nurses, practice nurses, physiotherapist and pharmacists) for the management of patients with long term respiratory conditions and delivery of education session to primary care staff to upskill them, within the Central and West Birmingham area.