Respiratory Virtual Clinics 2014-15
Guide for Primary Care Practices
1. Introduction
This document sets to explain the requirements to have an effective virtual
clinic within your practice with the Kings’ Health Partners (KHP)/Lambeth and
Southwark Integrated Respiratory Team.
The information in this document aims to clarify what to prepare in advance
and the expectations during and after a Respiratory Virtual Clinic. For
example, one practice found it helpful to prepare in advance “Patients
reviewed prior to Virtual Clinic to see who would benefit from discussion with
specialists”
As part of the medicines optimisation Prescribing Dashboard all practices are
required to achieve a ≥3% reduction in high-dose Inhaled Corticosteroids
items out of all inhaled corticosteroid items, measured between October and
December 2014 (Q3).
Respiratory Virtual Clinics will additionally form part of the Medicines Plan for
2014-15, as one of the optional elements. Undertaking a virtual clinic will
support your practice in meeting this target.
2. What are virtual clinics?
A respiratory virtual clinic (RVC) involves case discussions between members
of the KHP/Lambeth and Southwark Integrated Respiratory Team (IRT) and
the primary care clinicians. We regard it as a clinical session, not just a
meeting. Accordingly, practices need to protect and provide adequate time
(i.e. 2 hours) for virtual clinics to be most effective (i.e. a meeting over lunch
would not be appropriate).
The KHP/L&S Integrated Respiratory Team is a long term airways disease
team led by an integrated respiratory consultant. The team includes specialist
respiratory nurses, physiotherapists and pharmacists, and works closely with
local respiratory GP leads. The RVC is therefore aimed at focusing on your
COPD and asthma patients’ care.
The main component of the RVC is case discussions with the aim of
improving outcomes for patients with COPD and asthma. This focus should
therefore be on reviewing patients with a view to optimising high value care.
High value care in COPD and asthma means:
 Accurate diagnosis with quality assured spirometry
 Providing evidence based stop smoking support
 Offering patients access to pulmonary rehabilitation
 Responsible respiratory prescribing including inhaled corticosteroids for
the right patients
 Access to long term oxygen therapy for appropriate patients
 Recording and acting on exacerbations
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Offering patients supported self-management
Advanced care planning
The RVC should also be used to discuss patients causing diagnostic difficulty,
“hot” or “complex” cases and those where on-going support by the IRT at
home might be helpful.
3. How many sessions are offered?

All practices in Southwark and Lambeth will be offered one respiratory
virtual clinic session for the year. Practices that choose respiratory within
the Medicines Plan (option E) will be required to undertake a virtual clinic
and submit the required paperwork to receive payment.
 The majority of sessions will be undertaken by Dr Irem Patel,
integrated respiratory consultant at KHP/L&S CCG, supported by a
respiratory pharmacist, specialist nurse or physio from the IRT.
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Practices will also be able to access additional support from the IRT by
telephone or e-mail, and shadowing opportunities within the team can
be agreed for practice staff at the RVC.
Afternoon session timeslots will be made available for the RVC and it
will be necessary to book into these pre-advertised slots. Ad hoc sessions
will not be available due to capacity and other clinical commitments.
Practices may be recommended to have a follow-up / second visit (depending
on individual practices’ needs); this will be capacity-dependent.
4. Who is expected to attend the virtual clinic?
All clinical practice staff are encouraged to participate, and as a minimum the
following need to attend:
 1 x GP
 any practitioner with an interest in respiratory disease
Many practices invite the whole clinical team, as it is a chance to engage with,
and learn from, the experts in the IRT.
5. What is expected to prepare in advance?

The practice lead clinician must communicate the virtual clinic session
date to all relevant practice staff and confirm attendance.

Patients to be discussed at the virtual clinic need to be identified.
Searches will be made available to be uploaded on EMIS by practices in
advance (see section 9).

Select the patients to discuss within the virtual clinic based on search
results. The following patients are to be prioritised for review at RVCs:
a. COPD patients with FEV1 >50% predicted who are on high dose ICS
b. COPD patients with frequent exacerbations (> 2 per year) or high
respiratory symptom burden
c. COPD patients with FEV/FVC ratio above 0.7
d. COPD patients who are on monotherapy with ICS, even if not high
dose
e. COPD patients who are housebound
f. Asthma patients who are on BTS Step 4 therapy
g. Asthma patients over 35 who are also smokers – could they have
COPD?

It is helpful if patients selected for discussion have had up-to-date
investigations performed. For example spirometry including FEV1%
predicted, MRC score and a record of exacerbations in the last 12 months.
If patients are on COPD and asthma registers it would also be helpful to
have access to reversibility results.
Merge the with the search. This document will need to be reviewed for each
individual patient and any relevant missing information added in preparation
for the clinic
6. How will the virtual clinic(s) session be conducted?

Identify all patients with mild/moderate COPD that are taking inhaled
corticosteroids using the EMIS web search (to be supplied).

Complete the EMIS respiratory virtual clinic proformas for each patient

Members of the IRT will attend the practice at the agreed time to
undertake the virtual clinic

It is recommend that a minimum of 40 patients are discussed as part of
the virtual clinic

Patient-specific issues will be discussed, and interventions agreed for
individual patients. A clear action plan for each patient discussed
should be agreed. The practice will be expected to document the action
plan on EMIS/practice system.

Following the virtual clinic:
o implement actions identified
o review any remaining patients not discussed.
o Identify patients appropriately on high dose ICS and issue them
with an inhaled corticosteroid safety card when patient is next
seen within the practice.

A clear action plan for each patient discussed should be agreed. The
practice will be expected to document the action plan on EMIS/practice
system.

If the practice is participating in the Medicines Optimisation Plan option E
element, outcomes will need to be recorded on the standard proforma and
anonymised data submitted to the Medicines Optimisation Team at the
CCG, by end of March 2015. NB all patient-identifiable data should
remain within the practice – only anonymised data (eg with EMIS number
to retain a unique identifier) should be shared.

Virtual clinic bookings can be made from 1 April 2014
7. What are the expectations after the virtual clinic?

Patients with specific action plans should be reviewed as soon as possible
to discuss and agree actions.

Practices are requested to complete the IRT feedback form, to allow ongoing evaluation of the service.

Practices can access the respiratory Single Point of Referral
lamccg.respiratory@nhs.net using the standard EMIS referral templates
for any additional support / queries / referrals between virtual clinics.

If another session is agreed, the practice will need to arrange this with the
IRT (see section 8) to confirm a date.

If undertaking an additional clinic, practices may need to provide an
update on how they have implemented previous actions discussed (i.e.
patient has been recalled, contacted, seen etc) at the following virtual
clinic.
8. How to book your respiratory virtual clinic?
Contact Stu Lindsey (medical secretary to Dr Irem Patel, IRT) to book your
RVC.
Telephone: 0203 299 4740
Fax:
0203 299 2631
E-mail:
s.lindsey@nhs.net
Virtual clinics are offered on Monday, Thursdays and Fridays between 2pm
and 4pm:
Dates available for virtual clinics
9. Resources available to support practice to prepare for Virtual Clinic:
The following resources can be downloaded from:
2014/15 Medicines Optimisation Prescribing Resources
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EMIS searches to identify patients to be discussed at virtual clinic
EMIS respiratory virtual clinic proforma to collect individual
patient data for discussion at virtual clinic (also available in word
document)
Respiratory virtual clinic guide and checklist (this document)
COPD Standard Operating Procedure
Asthma Standard Operating Procedure
Asthma EMIS Web template
COPD EMIS Web template
10. Additional respiratory resources
 Inhaled corticosteroid safety cards – request via
lamccg.medicinesoptimisation@nhs.net

Availability of placebo inhalers - list of suppliers

Integrated Respiratory Team training events

Community Pharmacists:
o Medicines Use Reviews – refer using free text on EPS2
o New Medicines Service – refer using free text on EPS2
o Repeat dispensing
o Influenza vaccinations
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Respiratory Single Point of referral lamccg.respiratory@nhs.net