Chronic obstructive pulmonary disease in adults

Access and diagnosis: 225 patients diagnosed with asthma and 63 with COPD within weeks of referral, many receiving same-day diagnosis and treatment. Referral-to-treatment times fell from 24 to 52 weeks to under 6 weeks.

Accuracy and safety: 17 suspected cases of asthma/COPD were ruled out, preventing unnecessary medication. Misdiagnoses were corrected in 6% of patients (n=32), and inappropriate or harmful medicines discontinued (including beta-blockers, high-dose inhaled steroids, oral steroids, and NSAIDs).

Inhaler technique: 69% of patients had inhaler technique errors identified and corrected.

SABA reduction: All patients using 12 or more SABA inhalers annually improved symptom control and reduced usage after the intervention.

Avoided secondary care referrals: 90% of patients referred for difficult-to-treat symptoms were effectively managed in primary care, reducing wait times from up to 52 weeks to under 4 weeks.

Comorbidity management: 25% of patients received new or optimised treatment for coexisting conditions such as gastro-oesophageal reflux disease (GORD), sinonasal disease or cardiovascular risk factors.

Advanced therapies: 39 patients referred to the Difficult Asthma Centre for further input; 3 started biologic therapy via a fast-track MDT pathway, cutting wait times from over 52 weeks to under 12.

Population health impact: Although these can't be directly attributed to this project, COPD admissions in Dudley have stabilised despite national increases, moving Dudley from the highest to fourth highest admission rate in England. Asthma admissions are now the lowest in the integrated care board. SABA and prednisolone prescribing rates have been dropping and are now the lowest across the system.

Empowerment: Patient confidence in managing exacerbations increased from 66% to 99%. All patients received personalised self-management plans.

Feedback: 100% of patients rated consultations as "Excellent" or "Very good". All participating GP practices rated the service as "Excellent".

Specialists working alongside GPs and other clinicians can create a neighbourhood care model that can be scaled, reducing the burden on general practice.

Early, proactive specialist management shifts care from sickness to prevention while improving waiting times, patient experience, and outcomes.

Access to diagnostic tests within neighbourhood clinics ensures timely diagnosis and treatment, and helps identify missed or misdiagnoses.

Proactive patient outreach and education can reduce healthcare inequalities and empower patients to self-manage their conditions.

A 'one-stop' clinic model delivers high levels of patient satisfaction and positive experiences.

Improved quality of referrals to secondary care can be achieved through specialist advice and guidance within GP practices, using clear referral guidelines.

Cross-boundary collaboration, such as joint-satellite MDTs, optimises resources and accelerates patient access to treatments like biologics.

Early feedback highlighted the need for clearer referral criteria and better patient communication, leading to a new information leaflet and updated processes.

Sustainability and wider adoption require investment in training non-specialist clinicians, supported by an implementation toolkit that ensures fidelity while allowing local adaptation.

Following discussion with the local public health department, opportunities exist to enable direct referrals from clinics to housing agencies and school nurses, supporting early intervention, while community-based campaigns raise awareness of respiratory health.