CQC rating Requires Improvement

Respiratory

Annual respiratory reviews

Anyone with Asthma or COPD should have an annual review. This is to check if anything has changed with their illness; to make sure they are on the right medications; to help them manage their own illness and to give any information may need relating to their illness.

We have been trying to make these reviews as effective as possible in recent years but also realise that they are sometimes difficult to attend for people with busy family and working lives. With this in mind we offer a number of different ways of being reviewed, including questionnaires, telephone appointments, home lung function monitoring and by texting links to educational videos.

In the past we have also offered group educational events at each practice and we hope to expand this in the future and perhaps make some of these virtual. We are also working with a company who hope to help us do group reviews virtually. Group reviews are something we were looking at before the Pandemic because we know people learn a lot from talking and listening to people with the same condition. This is not possible face to face at the moment but we will keep reviewing the situation and maybe in the future will be able to restart the work.

We also audit patients notes to see who might need a more urgent review or perhaps need a longer face to face review. This may be because they are having lots of flare ups or because they are over-using medication. Face to face reviews usually last 20 minutes and are with one of our practice nurses trained in respiratory conditions. Telephone reviews usually last about 10 minutes and may be with a practice nurse or pharmacist trained in respiratory conditions. We will often send out a questionnaire before the review to help us see how things are before we ring you.

We will no longer be doing breathing tests in annual reviews for COPD. In 2019 annual breathing tests stopped based on national guidance, this was before the pandemic.
The test did not accurately tell us how bad your lung function is, and it is not a useful screen for lung cancer (which is what we used it for before).
What is more accurate is to check on your symptoms and how often you have flare ups.
We can ask you about these on a telephone review or when we meet you and arrange tests (eg: an xray)

Lung Function Tests

Lung function tests allow us to diagnose respiratory illnesses such as asthma and COPD. During the COVID pandemic GP many practices have been unable to perform lung function tests as there is a high risk of staff being infected with COVID from asymptomatic patients doing these type of tests.

The specialist respiratory team developed a way of performing these tests in patients cars reducing this risk and allowing testing to go on even during the pandemic. To the best of our knowledge we were the only GP practices who were able to do this in West Yorkshire during the last 18 months.

Thankfully in the last few months we have been able to come back inside with some increased precautions. We have also taken this opportunity to use new asthma testing to improve the certainty of our diagnosis. Again we are one of the only practices in Bradford to offer this testing.

There is a large waiting list for these tests due, in part, to the slow nature of doing these tests during COVID. We have also had to train a team of new practitioners to do the tests, as some of our team have moved on or retired over the last 2 years. Never the less we have managed to do 100’s of tests over the last 2 years and continue to expand the team to shorten the waiting list as quickly as we can.

Specialist respiratory clinic

We hold Specialist Respiratory Clinics at all the practices with our two specialist respiratory nurses Rob and Vicky.

What we do

Patients are seen in these clinics if they have particularly complex respiratory conditions or are still having problems with their breathing despite the best efforts of their GP or Practice Nurse. Patients are usually referred by their practice nurse or GP but may also be picked up following a hospital admission. This is a unique service to Affinity Care. The service maintains close links with the hospital respiratory team including the severe asthma clinic and Bradfords Respiratory Research Team. Patients are often referred onwards to the hospital respiratory team where needed but can be seen earlier than a hospital referral, usually within 4-6 weeks. Appointments are held at all practices though have mostly been by telephone during the COVID pandemic. We are looking to move towards more face to face appointments again as restrictions ease.

Car park lung function tests

Lung function tests allow us to diagnose respiratory illnesses such as asthma and COPD also help us to monitor these conditions. During the COVID pandemic GP practices have been unable to perform lung function tests as there is a high risk of staff being infected with COVID from asymptomatic patients doing these type of tests.

The specialist respiratory team developed a way of performing these tests in patients cars reducing this risk and allowing testing to go on even during the pandemic. To the best of our knowledge we are the only GP practices who have been able to do this in West Yorkshire during the last 18 months.

We have also taken this opportunity to use new asthma testing to improve the certainty of our diagnosis. There is a large waiting list for these tests due to the slow nature of doing these tests in peoples cars but we have been able to do over 150 tests since we started this 6 months ago. As restrictions ease we hope to bring these tests back inside in order to open the tests to everyone and reduce the waiting list but there is still considerable uncertainty over the safety of doing this and again no other GP practices in the area have so far restarted their lung function testing.

Inhalers

It doesn’t matter how good the drugs in inhalers are, if the drug isn’t getting into the lung properly. Research tells us that less than 40% of patients taken their inhalers correctly reducing their effectiveness. Our practice nurses and pharmacists can help with this and it also worth speaking to you local chemist if you are unsure.

Remember that there is no best inhaler and different inhalers suit different people. There are over 150 different inhalers we can try so if you arn’t getting on with yours, please ask us to consider a change. When you change your inhaler it is helpful if your practice nurse or pharmacist reviews you after 4-6 weeks, please ask if this doesn’t happen. The following videos and app can help with learning how to take your inhaler.

Remember many inhalers should be used with a spacer.

  • This should be changed yearly
  • Washed once a month
  • Primed when new or after a wash
  • Changed if becomes cloudy

Environmental impact of inhalers

In recent years we have become aware of the significant carbon footprint left by some inhalers. We have also learnt that the degree to which inhalers effect the environment varies considerably between the different inhalers and so it is sometimes possible to reduce our carbon footprint by using different inhalers.

We also know that COPD and asthma can be a scary and dangerous illness and the most important thing is to keep your illness as controlled as possible. For this reason a change in inhalers due to environmental factors is very much up to each patient. Please let us know if you would like to discuss this and we can arrange for a pharmacist or nurse to call you.

The inhalers that have the biggest carbon footprint are usually those that have a cylinder and omit an aerosol, we call them Metered Dose Inhalers or MDI’s. Particularly troublesome are the reliever (blue) MDI’s which cause the majority of the problems.

Please read the following article for how changing your inhaler might not only improve your impact on the environment but may also improve your asthma/COPD symptoms.

Why switching asthma inhaler could be better for you and the planet – BBC News

Asthma links

What does well controlled asthma look like:

  • No flare ups
  • Low use of Reliever (BLUE) Inhaler. No more than 3 times per week
  • Good sleep with asthma
  • Being able to exercise with asthma

Let us know if this doesn’t sound like you.

Asthma information Health advice | Asthma UK

WhatsApp ask about your asthma – WhatsApp service | Asthma UK

Asthma UK Helpline – 0300 222 5800 Helpline | Asthma UK

Self management plans – Asthma action plans | Asthma UK

Is my asthma well controlled? Asthma Attack Risk Checker | Asthma UK

Preventer Inhalers – Preventer inhalers | Asthma UK

Reliever Inhalers – Reliever inhalers | Asthma UK

COPD links

What is COPD? – COPD (chronic obstructive pulmonary disease) | BLF

COPD Flare Ups – COPD flare-ups | British Lung Foundation (blf.org.uk)

After giving up smoking, continuing to be active is the next most important thing you can do to improve your COPD. There are a number of ways we can help you with this:

Breathing exercises for COPD – How can I manage my breathlessness? | British Lung Foundation (blf.org.uk)

Support Groups – BLF support groups | British Lung Foundation

Support for those housebound with COPD – We can refer you to a support system called MyCare if you are very restricted by COPD. Please ask your GP or Practice Nurse for a referral to MyCare

Pulmonary fibrosis / interstitial lung disease

What is ILD/Pulmonary Fibrosis What is Pulmonary Fibrosis? – Action for Pulmonary Fibrosis (actionpf.org)

Support Groups Bradford Pulmonary Fibrosis Support Group – Action for Pulmonary Fibrosis (actionpf.org)

This condition is often managed by hospital consultants but our specialist respiratory nurses can provide support in between your appointments with the hospital. Please ask your GP/Pactice Nurse for a referral

Many patients will be referred to the Leeds ILD service. Talk to your consultant about this. Interstitial Lung Disease (leedsth.nhs.uk)

Smoking cessation

Bradford support 01274 437700 Smoking | Living Well (mylivingwell.co.uk)

Long COVID/Post Acute COVID Syndrome

Information – Post-COVID HUB – By Asthma UK and British Lung Foundation

Support Group – Home – Long Covid Support

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