Chronic Obstructive Pulmonary Disease (health and wellbeing needs in South Tyneside)

• The need for services for local people has been highlighted in several Department of Health documents in recent years. NICE^[1] recommends pulmonary rehabilitation as an important part of COPD management, in conjunction with optimal treatment and smoking cessation.
• The registered practice population of South Tyneside in July 2016 was 156,546.
• The QOF data 2014 / 15 for South Tyneside shows that 3.7% of the registered population has a confirmed diagnosis of COPD (all ages)^[2]; some 5,700 people. However the estimated prevalence of COPD (all ages) is 4.25%, which is around 6,500.
• In July 2016, 2,305 individuals had a recorded MRC score of 3 or above (eligible target patients for acute based pulmonary rehabilitation)^[3].
• In 2015 - 16 there were 706 admissions for COPD and 186 readmissions within 90 days.^[4]
• Chart 1, provides a breakdown of MRC scores as at 31-07-2016, for all patients registered In South Tyneside aged 16 years or over with COPD.

Pulmonary Rehabilitation

Pulmonary rehabilitation should be made available to all patients who consider themselves functionally disabled by COPD (usually MRC grade 3 and above). Pulmonary rehabilitation programmes should include multicomponent, multidisciplinary interventions, which are tailored to the individual patient's needs. The rehabilitation process should incorporate a programme of physical training, disease education, nutritional, psychological and behavioural intervention.

• The national NHS Pulmonary Rehabilitation service specification states "A community based service would focus on engaging patients with an MRC 3 or more". ^[5]
• In South Tyneside, this is the inclusion criteria for the acute based service. Chart 1 above shows there are 2,305 patients who are eligible to access the acute pulmonary rehabilitation service within South Tyneside.
• The above chart also shows that on the MRC scale of 1 - 5, MRC 2 has the most individuals recorded against this level of severity. Based on the current acute specification, 3,387 patients (MRC 1 & 2) are therefore not eligible for the current service, representing a considerable unmet need. Moreover, the respiratory health of many of these people may deteriorate, placing additional burdens on the system.
• Data obtained from local GP practices (from the Better Outcomes Scheme - practice incentive scheme) found that fewer than 50% of the patients attending the service were referred from primary care (the majority of referrals were from other local referring agencies or from self-referrals). In 2014 / 15 almost as many patients declined the course as attended. In 2015 / 16 more than three times as many patients declined the course as actually attended. Locally we have high rates of patients declining pulmonary Rehabilitation.
• It is important to raise that the patients who are not accessing the service (over the years of 2012 - 2016), are potentially having a significant impact on the system.
• According to the Better Outcomes Scheme data from 2014 - 2016, there were 1443 patients referred from GP practices who did not receive pulmonary rehabilitation, 256 of whom were deemed unsuitable and 1187 of whom declined to attend a course. Both these groups will use other services to treat their respiratory condition. Of those who declined to attend a course there will be many who could learn to self-manage, potentially reducing demand for other, more costly services.