National Paediatric Asthma Collaborative
Reducing Emergency Admissions Focus on Asthma and Viral Wheeze
Leading
Thames Valley Children & Maternity Strategic Clinical Network (TVSCN)
Partners
GP Facilitator, Nurse Specialists, and GPs and practice nurses plus school nurses, Primary Care
Respiratory Leads/Teams, Secondary Care Paediatric Leads, Children & Maternity SCN, Clinical,
Commissioning Groups.
Background
An educational project for doctors and nurses in primary care initially focused in Buckinghamshire
but widening to involve other CCG areas in the Thames Valley.
The broad outline of the project was developed in discussion with the Domain 1 Senior Network
Manager and the Children & Maternity Clinical Director for Thames Valley.
Logistical support and assistance for the development and pursuit of the project was provided by the
Children and Maternity Network Manager and Quality Improvement Lead.
Although the driver for this initiative was data on variability in admission rates for childhood asthma
it was considered very important that the project should have a general focus on quality and
outcome improvement and not focus specifically and explicitly on reducing admission rates.
Action
Building Awareness and Gaining Engagement
There was early liaison with CCG Child Health leads to coordinate with existing initiatives. Initial
contact via GP practice managers to identify respiratory leads in practices using CCG circulation lists
for emails. Early liaison with CCGs was vital to enlist support. Announced meeting dates – aiming at
least for attendance by practice respiratory leads/teams but others welcome.
Rationale for the GP Facilitator Role
The aim was both to design and provide educational materials around childhood respiratory care
that could be delivered at CCG – wide meetings (aiming to attract doctors and nurses with a
respiratory interest) but also provided on memory sticks and online so that participants were
enabled and encouraged to use these materials for in-practice educational meetings.
It was felt that this would be best facilitated by practising GPs with a paediatric respiratory interest;
combining an authoritative command of the clinical evidence with current real world experience in
the delivery of care in a general practice setting.
The Buckinghamshire GP Facilitator (GPF) is an experienced local general practitioner and the Policy
National Paediatric Asthma Collaborative
Lead on the Executive Committee of the Primary Care Respiratory Society UK. He has a significant
track record of publication in peer- reviewed journals in the field of respiratory care and was
responsible for the initial authorship of the chapter on childhood asthma for BMJ Clinical Evidence.
He also has extensive experience as a clinical educator.
What is the GP aiming to achieve and how
In Buckinghamshire the aim was to design a half day meeting and then to roll out to as many other
localities across Thames Valley as possible – priorities being Berks East, Bucks and Milton Keynes –
ideally jointly run by GP, Nurse specialist and Paediatrician . The meetings where possible are tied
in with GP Practice PTL days where these exist. The aim is to equip practice respiratory leads with
the ability to run sessions in their own practice (with PowerPoint presentations and supporting
materials provided by the project).
The suggested time for the initial main meetings was October / November 2014 – and potential
initial venues included High Wycombe, Aylesbury, Milton Keynes and Slough.
It was also recognised that there would be a need to design a presentation / PP suitable for a 1 hour
session and suitable for fitting into practice training sessions/lunchtime meetings.
Key Supporting Resources – Local care pathways, PCRS UK opinion sheets on diagnosis of asthma in
children, management of asthma in children. Asthma UK self-management materials. Flyers for E4H
training courses. Video clip on spacer use for treating acute wheeze. NICE asthma quality standard,
BTS/SIGN guideline, Good Practice Guide for commissioning
Structure of Training and Outcomes
The training materials were developed by the GPF with the input and involvement of a consultant
paediatrician, the Children and Maternity Clinical Director and some respiratory nurse specialists.
All the materials are available to view on the TVSCN website at
http://tvscn.nhs.uk/networks/maternity-and-childrens/network/children/respiratory-illnesschildhood/
The website also contains advice on how to organise and structure large group meetings along the
lines of the meeting already run in Thame Valley. These materials are available to other networks
and localities and have attracted interest from outside the Thames Valley area.
The materials include suggested Read Codes for key quality markers in childhood asthma care.
The precise structure of the meetings has varied from CCG to CCG.
The GPF gave a 40 minute summary presentation at the Chiltern and South Buckinghamshire CCG
PTL Educational Event in October 2014.
In Bucks the main event was a half-day session in Aylesbury on 19th November 2014. This was
funded and organised by TVSCN with vital logistic support for publicity and meeting organisation
from the Thames Valley Strategic Clinical Network team.
The meeting was attended by 70 doctors and nurses with participation of the Aylesbury Vale CCG
Maternity and Child Health Lead, and by a keen local pharmacist with a respiratory interest, The
Aylesbury meeting was a resounding success and feedback from participants was excellent.
National Paediatric Asthma Collaborative
All the materials were provided for running in-practice meetings were provided to the participants
on memory sticks and online.
The Aylesbury meeting was attended by representatives from Milton Keynes CCG – who then led on
the very successful delivery of a similar half day PTL meeting in Milton Keynes on January 22nd 2015
for which the GPF joined as a member of the presenting team. There were 101 attendees in total for
this event, 86 of which were doctors and nurses.
Buckinghamshire meetings were also used to promote and present an excellent set of pathway
documents on childhood wheezing and asthma that had been produced and disseminated by the
CCG teams.
In Slough two successful PTL meetings with a childhood asthma focus were held; the events
attracted a total of 131 attendees, of whom 128 were doctors or nurses.
At the second of these meetings, on Wednesday 25th February 2015 the GPF contributed a session
on respiratory diagnosis in children, and attention was drawn to the suite of materials for in-practice
meetings which were again made available to participants on memory sticks prepared by Thames
Valley SCN and online. There was representation and support for this event from the Thames Valley
SCN.
All these meetings have also been used to promote and demonstrate the Puffell online platform for
patient and parent self-management support.
A further meeting half day meeting following the Aylesbury/ Milton Keynes model is planned for
May 20th 2015, with the involvement of a consultant paediatrician, respiratory nurse specialist, CCG
respiratory lead and a CCG Maternity and Child Health Lead.
We are also in the early planning stages of a half day PTL event for Bracknell aimed to run on
September 10th 2015.
Outcomes
Evidence for impact on outcomes for a project such as this is hard to come by, but analysis of
admission rate trends in Thames Valley will be undertaken to look for any evidence of downward
trends.
It may prove possible to propose searches on GP computer databases for key Read Codes proposed
as quality markers –although achieving standardisation in coding practices other than in areas
specified by the QOF is a challenge.
Next Steps
The large group meetings organised through the project have been a clear success. Success in the
aim of having participants hold in practice meetings using the educational materials developed is far
less clear. Further activity to promote such meetings and capture evidence of effectiveness is
necessary.
Publicising the model and the materials to other NHS areas will be worthwhile given the interest
already shown. This will be particularly important if any evidence emerges for effectiveness at the
level of outcomes – such as admission rates for childhood respiratory problems, or for success in
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motivating practices to use project material for in-house educational events.
Learning
Key Learnings from the project so far:
1. Leaders from within primary care can play a powerful role in attracting participation and
motivating learning and the dissemination of learning for primary care professionals, but
that support and involvement from respected opinion leaders from secondary care is also
very important.
2. Multi-professional cooperation in the production and dissemination of educational materials
increases their impact and models the multi-professional cooperation necessary for good
patient care.
3. Securing good attendance at educational meetings around childhood respiratory care is a
challenge, but one which can be successfully overcome by repeated publicity to practices by
all available channels.
4. Articulation of a project like this with existing initiatives under way in CCGs (in this case for
example: the pathways development programme of Buckinghamshire CCG) is vital to
achieve synergy between different educational efforts around any particular topic.
5. To ensure that the key educational messages have a very close fit with pathways and policies
at a local level, contact at an early stage with key players in the CCGs is necessary.
6. It is vital to involve, liaise and cooperate with existing local respiratory education groups.
7. The availability of funding from non-pharma sources (in this case TVSCN ) for educational
initiatives is conducive to better attendance and a higher degree of trust by participants in
the disinterested nature of the educational messages (this perception is based on personal
communications).
8. Involvement of community pharmacists in a project such as this is highly desirable but hard
to achieve.
Top Tips

Repeated publicity to practices by all available channels.

Run educational sessions where possible as part of GP PTL sessions to encourage attendance

Engage respected opinion leaders and multi-professional cooperation in participation,
motivating learning and dissemination of learning.

Early contact with key players to move things forward.

Provision of training materials including key national guidance.

Use GP profile data to help inform about local view and focus target areas
National Paediatric Asthma Collaborative
Further information
All the materials are available to view on the TVSCN website at
http://tvscn.nhs.uk/networks/maternity-and-childrens/network/children/respiratory-illnesschildhood/
Contact
Marion Foster, Quality Improvement Lead Marion.foster@nhs.net