Tools and resources

5 New models of care

The NICE guideline on asthma suggests that 'new models of care, being developed locally, could offer the opportunity to implement these recommendations'. Contributors to this resource have suggested the following ways to ensure that the asthma diagnosis recommendations are a priority during the development of new models of care.

Implementation team

Consider including the following people into the wider implementation team to support asthma diagnosis:

  • Clinical champions: healthcare professionals with the relevant knowledge and understanding to drive implementation, answer clinical queries and champion the project at a senior level. At the feasibility project sites this was a lead GP and lead nurse.

  • Implementation manager: someone in a clinical or managerial role to be responsible for the day-to-day implementation plan, co‑ordinating the team and ensuring progress is made. This may be a practice nurse, respiratory nurse or practice manager.

  • Management sponsor: to help assess the financial viability of implementation, ensure the business case is produced and help to show the cost savings achieved. This may be the practice manager or a lead from the clinical commissioning group.

  • Audit facilitator: to help set up systems to collect and analyse local data needed to measure performance and carry out audits. This may be an IT systems manager or practice nurse.

  • Other stakeholders or staff, including:

    • local active respiratory forums or working groups

    • primary care pharmacists

    • medicines optimisation teams

    • GPs with a special interest in respiratory medicine

    • GP partners from their own and neighbouring practices

    • representatives from community respiratory services

    • practice receptionists

    • secondary care respiratory physicians with a special interest in asthma

    • commissioner with special interest in asthma

    • patient advisory group members.

Different working models

The NICE guideline suggests that developing new models of care to implement the recommendation 'may involve establishing diagnostic hubs to make testing efficient and affordable'. Contributors to this resource supported incorporating implementation of the asthma diagnosis recommendations into service redesign that was broader than just asthma diagnosis and encompassed asthma management and services for other relevant conditions such as COPD, lung cancer, heart failure and cardiac arrhythmias.

One contributor reported that when secondary care staff work in a primary care service to support respiratory diagnosis (perhaps 1 clinic per week) it provides additional expertise to primary care and an opportunity for sharing of skills and learning.

Consider what services are already established, if any service redesign is underway or planned, and how asthma diagnosis could be integrated within this.

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