PATIENT PARTICIPATION 
COPD Patients at 
Caen Medical Centre
on Tuesday 20th November 2018

Attendees				
Dr Brian Bennett					Geoffrey Lang		
Nurse Val Hing					Allan Pitches
Sue Bennett, Practice Manager			Alan Poulton
Veronica Clarke					Geoffrey Triggs
Debra Cooper					Christopher Branston
Michael Dash
Margaret Holtby 

The practice invited 24 patients who have a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) to attend today’s patient participation group meeting, 9 patients accepted the offer and attended today’s meeting.

Welcome/ Introduction
Dr Bennett started the meeting by welcoming and thanking everyone for taking the time to attend.  He explained that we hold patient participation group meetings on a quarterly basis inviting selected groups of patients with particular needs or conditions to discuss how we are doing at meeting their needs, the experiences they have encountered and how we might improve our services by asking them for their perspective on the service offered. 

Dr Bennett then opened up the meeting for discussion and the following topics were raised. 

What is COPD?
Dr Bennett explained that COPD develops over time and is not an instant diagnosis.  Asthma can develop into COPD overtime for some people.  Conditions such as asbestosis also develop over time and may take as long as 20 years to fully present.  Deteriorating symptoms are usually an indicator that COPD is developing.  Smokers are also at a higher risk of being diagnosed with COPD.  He explained that bronchitis is also a form of COPD.

Appointment Availability/Access 
One patient said a direct line to a respiratory nurse should be provided so that if a patient with COPD is experiencing breathing difficulties they have direct access.  Dr Bennett explained that neither CREADO nor the GP surgery is an emergency service and that if any patient is experiencing shortness of breath that they should contact 111 for urgent advice and guidance or in life threatening cases call 999.

A couple of patients said they could wait up to 1½ weeks for an appointment.  Dr Bennett explained that this might be the case if you wanted to see a particular GP or nurse or wanted to attend on a specific day.  He advised all the patients present that the practice will never turn any patient away and if we have no bookable appointments left on the day and the patient feels they need to see a GP that day we have a telephone triage service and the patients name will be added to the list for the on call doctor to call back.  This doctor will then assess the situation and if needed see the patient that day.

Patients who use on-line access to book their appointments at the practice extol the virtues and would recommend others to use it.

Spirometry Testing
All patients will have a spirometry test to help confirm their diagnosis of COPD and once diagnosed this will be performed annually to monitor change and deterioration in a patient’s condition.

Nurse Hing explained that over the past few years we have introduced hand held spirometry monitors which have greatly reduced the amount of time the patient needs to spend in the practice for this test.

All the patients present have attended for spirometry testing at the practice.

Medication and Treatments
Nurse Hing and Dr Bennett explained that in the past inhalers used to treat asthma were also used to treat COPD and largely this treatment was ineffective.

The introduction of new inhalers specifically for COPD treatment is more effective but some patients have been reluctant to change their inhalers.

Nurse Hing and Dr Bennett explained that changing inhalers can be difficult and there will be a period of transition which could be turbulent but it is important that patients are on the correct and most appropriate treatment for their conditions as this helps to keep exacerbation and infections at bay. 

One patient with a long history of COPD said he felt the diagnosis and treatment of COPD was better of late.

The importance of stopping smoking was discussed.  Most of the patients present said they had either previously given up smoking or not smoked.

One patient asked how often they should attend for a COPD review, was 15 months sufficient.  Nurse Hing explained that every 12-15 months was acceptable providing the patient felt their COPD was stable but she encouraged anyone who was experiencing difficulties not to wait to be invited to attend and to book an appointment to see a respiratory nurse or their GP.

Ordering of acute and repeat medication was discussed.  One patient asked why only repeat medication was visible on-line for them to re-order and not acute medication.  Dr Bennett explained why inhalers do not automatically go onto a patients repeat medication.  It is important that patients do not over use their inhalers and sometimes the doctor or nurse may wish to monitor a patient commencing on new inhaled treatment to ensure it is the correct and best medication for that patient.  Nurse Hing said that she will always ask a patient to return after one month of starting a new inhaler to check it is suiting the patient.

The importance of inhaler technique was discussed.  Nurse Hing explained that if a patient is not using their inhaler correctly they will not be receiving the correct dose of medication.  It may also falsely imply that a patient is over using their medication when in fact they are not using their inhaler correctly.

Self-Management Plans are issued by the practice respiratory nurse when seeing COPD patients at annual review, these are then reviewed at subsequent reviews with the patient.  The patients said this is a useful document which holds good information which they can follow.

Support Services/Groups
Nurse Hing explained that NDHCT runs a Pulmonary Rehabilitation course which patients can be referred to by their clinician.  The sessions are held either in Barnstaple or Ilfracombe and the course runs for 6 weeks.  One of the patients in the group said they were currently attending this course and found it beneficial.

Dr Bennett explained that the CREADO team employed by NDHCT is an Early Assisted Discharge Team who facilitates earlier discharge from hospital and support in the community for patients having had a hospital admission due to COPD.   He reiterated that this is not an emergency service for COPD patients to contact in crisis.

There is also a local Shortness of Breath club which runs monthly in the village hall at Wrafton between March and September.  One patient in the group that has attended this meeting said that it felt more like a social event rather than a learning event.

Outcome/Changes Suggested
•	Practice to continuing issuing self-management plans with a view to all COPD patients holding their own copy.
•	Practice team and patients to promote on-line access registration to the wider community 

Summary/ Discussion
Dr Bennett thanked all the patients present for attending today’s meeting and for sharing their views and giving input to the service we provide and how it might be shaped in the future.  

The patients commented that they felt the service offered at Caen Medical Centre and NDDH was very good.