Primary care teams can check they have appropriate resources, knowledge and skill mix to diagnose and manage patients with asthma and COPD through a tool developed by the Primary Care Respiratory Society (PCRS).
The PCRS quality improvement tool allows users to benchmark their own staff against recommendations for respiratory training and skill levels made in the organisation’s Fit to care framework which identifies the skills required for clinicians providing ‘standard’, ‘advanced’ and ‘expert’ respiratory care.
The tool is part of a new resource library for respiratory care, searchable by clinical area (such as asthma, lung cancer or COPD) or pillar of care (from prevention and treatment, through to end of life care). Each resource has a label indicating whether it’s a paper, podcast, video etc and a clock face indicating the likely time commitment associated with the resource (for example the podcasts are usually around 15 minutes, but a full peer reviewed journal may take 30 minutes or more to read thoroughly.
The project was planned to help support clinicians with the information needed to improve respiratory care, including papers, podcasts, videos and examples of good practice.
Patients with respiratory disease deserve equal access to early and accurate diagnosis, high standards of care, delivered by practitioners with suitable training and experience, PCRS said.
The quality improvement tool framework recommends that clinicians caring for patients with respiratory disease in primary care should ideally have training such as a diploma module in asthma or COPD, NCSCT training and assessment programme for smoking cessation or equivalent, those clinicians responsible for making an initial diagnosis and caring for patients with complex needs should ideally have a Master’s Level education.
‘Clinicians are being put in a position to make a diagnosis that they are perhaps not qualified to do so’, said Dr Daryl Freeman, Associate Clinical Director for Norfolk Community Health & Care and who has been a driver of the PCRS project.
‘One of the big concerns that PCRS has – as does many other parts of the respiratory world – is that many patients are being seen by clinicians who don’t have the training and expertise to diagnose respiratory disease correctly and to manage it. That’s not fair on anyone – on the clinician who is being put in that position or on the patient – and it’s not fair on the health service in general, because there is evidence that results in poor outcomes.
‘So we have developed a skill audit, in the form of a questionnaire. It asks each clinician to list their qualifications and to list what they are doing – do you make a diagnosis? Do you change management? Do you institute management? Do you prescribe? We benchmarked that against Fit to Care – which lists very clearly what qualifications a clinician should have for various levels of clinical care being delivered to the patient – standard, advanced and expert.
‘If you are going to be making a new diagnosis you should be working at expert level and have a Master’s level education, and we know that’s not the case in most primary care settings. In addition, we have lots of resources to help, such as job descriptions at standard, advanced and expert levels.
The tool gives an estimate of how many advanced, standard and expert clinicians are needed to run a respiratory service across a selected population size. ‘So, if I’m a clinical director of a PCN – I can see how many clinicians I need; against who I have now, and identify skill gaps,’ she says.
Practice managers, and individual clinicians, can also use the tool to support applications for training, budget, and recruitment.
The PCRS project took several years to complete. ‘I am incredibly proud of what we’ve all managed to achieve,’ said Dr Freeman.