How do we improve the provision and use of unscheduled urgent care services by adults with chronic obstructive pulmonary disease in Bristol?

Problem

Reducing unscheduled use of urgent care services is one of the biggest challenges currently facing the National Health Service (NHS). Year after year, official statistics show that people living in Bristol are more likely to be admitted to hospital unexpectedly than their counterparts regionally or nationally. Emergency admission for acute presentations of chronic obstructive pulmonary disease (COPD) is particularly common with local admission rates some 25% higher than the national average. However, there is no local, system-wide strategy to address this problem at present.

Approach

We undertook a series of semi-structured interviews with key stakeholders representing primary, secondary and tertiary healthcare as well as community and social care services across Bristol. The data from these consultations were used in two ways – firstly, to draft a schematic illustrating how the various services were accessed or interconnected and secondly, to understand how and where service improvements might be made and who should be involved in those decision-making processes.

Findings

A total of 17 interviews with healthcare professionals, managers and patients with COPD were completed. These provided insight into services from 22 local care providers covering a geographical space governed by two acute hospital trusts, one cluster clinical commissioning group and three local authorities. All of these organisations were represented on a ‘map’ which summarised local service provision. Thematic analysis of the data highlighted a number of issues (knowledge, ownership, resourcing, capacity and communication) which seemed to affect both the provision and use of services universally whilst other issues (isolation, co-morbidity, risk aversion) were aligned more with specific providers or individual experience.

Consequences

This exploratory qualitative work was valuable because it enabled the mapping of referral networks, patient flows and care pathways for acute exacerbations of COPD in a complicated and frequently changing multi-agency environment. It also allowed local stakeholders to reflect upon current provision with a view to future planning. Further dissemination work is required to ensure that those factors which seemingly influence or challenge service provision and use are well understood within and across appropriate communities of practice. As a result of this knowledge mobilisation, we hope that the research will inform quality improvement, integration and system reconfiguration in a way that will benefit both the NHS and its end-users.