The National Clinical Programme (NCP) Respiratory, along with NCP Diabetes and NCP Heart Failure, form the main components of the Integrated Care Programme for Chronic Disease (ICPCD). NCP Respiratory, as part of the ICPCD working alongside the Enhanced Community Care (ECC) Programme, is currently focused on the implementation of the Integrated Models of Care for COPD and Asthma. These Models of Care use an end-to-end patient-centred integrated approach for the prevention, early detection, slowing of disease progression, and the provision of optimal management for people with COPD and Asthma. Our models are very much in keeping with the Sláintecare vision of ‘Right Care, Right Place, Right Time’. Community Specialist Respiratory Teams within Integrated Respiratory Services are already functioning and this new way of working is already shifting patient care to the left, away from our acute hospitals.

NCP Respiratory Team

The current NCP Respiratory Team also includes:

• Clinical Lead Dr Stanley Miller,
• ICGP/HSE GP Lead Dr Shane McKeogh
• HSCP Lead Olga Riley 
• Programme Manager Susan Curtis

Our NCP Nursing Lead post is currently unfilled at this time.

RCPI Respiratory Clinical Advisory Group

The RCPI Respiratory Clinical Advisory Group (CAG), currently chaired by Prof Stephen Lane, meets on a quarterly basis and continues to provide valuable support and guidance NCP Respiratory.

Respiratory Integrated Care Consultants

There are currently 8 Respiratory Integrated Care Consultants in post in Ireland. All Respiratory Integrated care Consultants are providing a continuum of respiratory care across both our acute hospitals and Specialist Ambulatory Care Hubs, are actively developing clinical pathways including admission avoidance, and are providing leadership for their Integrated Respiratory Services. Consultant posts within a common Clinical Health Organisation (CHO) are collaborating and developing strong links between their neighbouring services. There is good general engagement between consultants and their local governance and CDM steering groups. Weekly Multidisciplinary Team (MDT) Meetings include key personnel from both acute and community based Integrated Respiratory Services. Cases are discussed obviating the need for acute hospital outpatient consultant attendances, and supported discharge strategies from the acute hospital into the community are facilitated. All consultants are either actively preparing for consultant-led clinics in their associated Specialist Ambulatory Care Hubs, or are already delivering same. Some consultants are already delivering respiratory out-patient clinics for complex cases in the acute hospital setting. The National Clinical Lead, supports his Integrated Respiratory Consultant colleagues through monthly meetings. NCP Respiratory would like to take this opportunity to thank the centres where existing acute hospital consultants have been supporting the early development of Respiratory Integrated Services in the absence of dedicated Respiratory Integrated Care Consultants.

GP Chronic Disease Management Programme

A very important foundation to what we are trying to achieve in NCP Respiratory, is the vital role that our GP colleagues play in the delivery of the Structured Chronic Disease Management (CDM) Programme in General Practice for our COPD and Asthma patients programme. CDM reviews are twice yearly structured reviews in GP surgeries for patients aged over 45 with a medical card who are diagnosed with one or more of the chronic diseases Asthma, COPD, Cardiovascular disease, and Diabetes.

The CDM programme, running since 2020, has yielded some encouraging results in its first 2 years which have recently been published as “The Second Report of the Structured Chronic Disease Management Treatment Programme in General Practice". 91% GPs are participating in the CDM programme. 83% eligible patients aged 65 years and over are enrolled in the programme with 800,000 reviews having been carried out by GPs and practice nurses. 91% patients with chronic disease are now fully routinely managed in primary care and are not attending hospital for the ongoing management of their chronic condition (see also https://www.icgp.ie/)

Specialist Ambulatory Care Hubs

To support this CDM in General Practice, the Integrated Models of Care for COPD and Asthma provide a continuum of patient-centred specialist Respiratory Integrated Care across both community-based specialist Ambulatory Care Hubs and their associated acute hospitals. This patient-centred integrated care is being delivered by community-based Specialist Respiratory Teams within Specialist Ambulatory Care Hubs, and by COPD Outreach Teams based in our acute hospitals. Through the ECC Programme, funding has been secured for 30 Specialist Ambulatory Care Hub-based Respiratory teams, consisting of 295 staff with 98 being dedicated Pulmonary Rehabilitation providers. Additional ECC funded COPD Outreach Services provide a vital role by both facilitating admission avoidance through our emergency departments and supporting the early discharge of patients from our acute hospitals.
The Integrated Respiratory Services available, tailored to the individual needs of the patient, already include:

• COPD Outreach
• Consultant-led Respiratory clinics
• Nurse-led and Physiotherapy-led Respiratory clinics
• Multi-disciplinary team meetings to optimise patient management
• Links with chronic disease management and other specialist services
• Early detection of disease and diagnosis (Spirometry)
• Pulmonary Rehabilitation
• Oxygen clinics

This current new way of upstream working is fundamental to the provision of early intervention in COPD and Asthma which also contributes to the avoidance of crisis admissions to our acute hospitals (further information on ICPCD hub on hseland).

GP Access to Spirometry

An essential component of the Models of Care for COPD and Asthma is supporting direct GP access to Spirometry primarily to aid diagnosis. The ICPCD is working closely with the ECC Programme & Primary Care Contracts to establish an equitable and timely direct GP access Spirometry service across Ireland. To that end, funding has been provided for 48 WTE permanent senior respiratory physiologist posts with administrative support, in addition to the procurement of the necessary additional equipment, to deliver ring-fenced direct GP access Spirometry services. NCP Respiratory has a collaborative relationship with the Irish Institute of Clinical Measurement Physiologists (IICMP) to develop and support a strategy for both the recruitment of new physiologists and the re-accreditation of health professionals with pre-existing Spirometry training.

Local Engagements and Site Visits

NCP Respiratory continues to facilitate local engagements and site visits with Community Healthcare Organisations (CHOs) and Hospital Groups to support local implementation of the Models of Care for COPD and Asthma. Throughout 2023 NCP Respiratory will be travelling around the country visiting all Integrated Services in person. The primary focus for our visits is supporting the implementation of the Models of Care. We purposely meet all Integrated Teams within a particular CHO together, as it provides an excellent opportunity for shared learning and support. We are also eager to embrace and encourage any local innovations and initiatives if they complement the new Models of Care.

Patient Advocacy Groups

NCP Respiratory meets regularly with COPD Support Ireland (COPDSI), the Asthma Society of Ireland (ASI) and the Alpha-1 Foundation Ireland. All parties have agreed on a collaborative approach to compliment the Models of Care for both COPD and Asthma. The Asthma Society of Ireland delivers patient advice lines for both Asthma and COPD (in collaboration with COPDSI) and COPDSI delivers COPD patient support groups. NCP Resp successfully advocated for ongoing financial support for COPDSI to deliver their COPD support groups throughout 2023.

New NCP Resources

The NCP Respiratory launched several new resources in 2022. The Pulmonary Rehabilitation hseland eLearning module on Assessment and Exercise Prescription was launched in April 2022. This online event also marked the launch of new Pulmonary Rehabilitation resources. Pulmonary Rehabilitation infographics for patients were developed with input from COPD Support Ireland, and Pulmonary Rehabilitation resources for GPs were developed with input from ICGP. These infographics are available on the HSE website in print and online friendly versions. NCP Respiratory have also worked with expert and experienced healthcare professionals to develop updates on the National Guidance document for Virtual Pulmonary Rehabilitation and Oxygen Assessment and Review. These guidance documents are due to be launched in 2023.

Training on Dyspnoea Assessment and Management, and Video Enabled Care

NCP Respiratory received funding to provide training for 180 healthcare professionals on the Breathing Thinking Functioning model of Dyspnoea Assessment and Management. Each attendee committed to providing educational feedback to at least 5 colleagues bringing the new learning to over 900 healthcare professionals. NCP Respiratory also organised an online event for the HSE eHealth Programme and Pulmonary Rehabilitation providers in October 2022. At this event, the eHealth Programme provided a presentation on the services and supports available to facilitate video-enabled care, with a focus on Pulmonary Rehabilitation. The event was attended by over 30 Pulmonary Rehabilitation providers.

The NCP Respiratory vision is for an end-to-end patient-centred integrated approach for people with COPD and Asthma. Our GPs are playing a vital role in the delivery of the Structured CDM Programme in Primary Care for our COPD and Asthma patients which provides a solid foundation for what we are trying to achieve. An essential component of the Models of Care for COPD and Asthma is direct GP access to Spirometry. The new Integrated Respiratory Consultant role provides a continuum of care across both our Acute Hospitals and their associated Specialist Ambulatory Care Hubs. The Integrated Models of Care for COPD and Asthma are very much in keeping with the Sláintecare vision of ‘Right Care, Right Place, Right Time’ and this new way of working is already helping to shift patient care to the left, away from our acute hospitals.

Please direct any enquiries to the programme manager at susan.curtis@hse.ie