Using the GIRFT Report to reduce healthcare variations

When I look at the outcomes of the Getting It Right First Time (GIRFT) report, I’m
struck by two things:

• Firstly, there’s lots in there that we as respiratory health-care professionals can be proud of,
•  Secondly, we still have lots of areas we can improve in.

Many of the improvements in the report focus on tackling the variations that currently leave some people struggling to access the same care as others.^[1]

Fundamentally, one of the key takeaways from this report is how we can remove some of those variations to reduce health inequalities and offer everyone a consistent level of care.^[1]

Multi-professional teams and holistic care

In respiratory medicine, we’re used to working in multi-professional teams where nurses and allied health professionals play an integral role. Particularly in an acute care setting, respiratory nurses, physiotherapists, and pharmacists are at the forefront of everything we do.

Members of the community respiratory services are often those dealing with patients regularly and often have the best knowledge of patients as individuals. That means they’re usually best placed to assess a patient’s individual needs and provide holistic care based on their socioeconomic backgrounds and family and social support.

Working so closely with patients to create that holistic care with a multi- professional team is key to reducing health inequalities.^[1] It means factoring in differences between patients and ensuring those differences don’t impact their level of care.

One way I’ve seen this work is through the use of discharge bundles to COPD patients before they go home from hospital. Respiratory clinicians with first-hand experience of their patients can make assessments and implement the most effective interventions for each patient in their discharge bundle. In doing so, they can help improve a patient’s outcomes.

The importance of a designated space

The GIRFT report also highlights the importance of having a designated space for specialist care – this has become especially apparent in light of the COVID crisis. Having a designated space to deal with ongoing and long-term conditions outside of intensive care was critical. By managing conditions in a dedicated space, such as the respiratory support units (RSUs) mentioned in the report, teams can provide more sophisticated and coordinated care. This helped keep patients with ongoing illnesses out of intensive care.^[1]

Innovating existing care

The basic concept of an RSU is not a new idea. But in laying out the details, the report will help extend what already works in some areas and make it transferable and adaptable for every trust. It’s one of the many ways we can share best practices to help reduce health inequalities and ensure everyone has access to the same standard of care – wherever they’re based.

Another way we can do this is to look at what we’ve learnt from the COVID pandemic. During the pandemic, COPD exacerbation admissions fell by 50%.^[2] So, it’s important to understand what may have contributed to that and to share best practice to get to the heart of the GIRFT report and get it right first (and every) time.

Much of the reduction will have been linked to the shielding done by most patients with more severe COPD. Obviously, we can’t expect people to shield in the longer term. What we can do is take note of the adjustments patients are comfortable with.

That could be things like:

• Sticking to better hand hygiene
• Wearing masks during appointments, and clinicians wearing masks too
• Offering online clinics

We can use those things to better support patients and advise on self- management techniques to improve their outcomes.

What we must do moving forward, though, is to keep one eye on digital exclusion. For example, in offering digital appointments and support, we need to make sure we’re not excluding those who don’t have online access or the right data plan and exaggerating those health inequalities the GIRFT report aims to tackle.

While we take on board the learnings from the last year and start to share those best practices, we must not risk leaving certain people behind in doing so. Everyone living with COPD deserves access to the best standards of care.

Any advice given and opinions expressed in this article are those of the author and do not reflect the view of Chiesi Limited (Chiesi).  All content in this article is for informational and educational purposes only.  Although Chiesi strives to always provide accurate information, it is not responsible for and does not verify for accuracy any of the information contained within.

[1] NHS England and NHS Improvement. Respiratory Medicine GIRFT Programme National Specialty Report 2021. Available at https://future.nhs.uk/GIRFTNational/view?objectId=112161701. Accessed October 2021.

[2] Alqahtani JS, Oyelade T, Aldhahir AM et al. 2021. Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis. PLoS ONE 16(8): e0255659