What was the challenge?

The NHS Long Term Plan highlights the need for improved treatment and support of people with respiratory disease. Plans include expanding pulmonary rehabilitation (PR) services across the country so that patients who would benefit complete treatment in a good quality service. PR services can join the Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS) that aims to improve the quality of PR services leading to accreditation. 

The pathway to accreditation takes up to two years and involves self-assessment against 40 standards and preparation of evidence to show that those standards are met. Once this is completed the service is assessed with a review of the evidence and then a site assessment of the PR sessions.

The Gloucestershire Respiratory Team had an ongoing challenge to be able to dedicate time to focus on starting their accreditation journey.  

“Challenge is with operational duties for the service, to be able to have time to give to this. Feels to limit general momentum of this.” (Respiratory Clinical Leads)

Who we are

NHS SCW (South Central and West) are an NHS organisation providing support and transformation services to health and care systems, helping them achieve the best possible outcomes for people, communities, and populations.

• We are a non-profit-making part of the NHS, with shared values and goals for healthier, happier lives. Any small surplus we make is reinvested back into the NHS for the greater good.
• The Cancer and Long-Term conditions team at SCW comprises programme managers and clinical project managers who are registered clinicians. This includes physiotherapists, nurses, and radiographers who are able to provide subject matter expertise and clinical insight to projects and programmes of work.  

In 2022, SCW were approached by Gloucestershire Integrated Care Board to support their PR service to prepare for their PRSAS accreditation – a process that can take up to two years from start to finish. 

What we did

SCW focused support on helping Gloucestershire with the start of their PR accreditation journey.  We worked with the Gloucestershire respiratory team to understand more about their current systems and identify areas for improving the service.

1. We conducted a gap analysis to collate what current PRSAS evidence Gloucestershire had using the self-assessment tool to understand:  
   
   • which standards they met and had evidence for
   • which standards they met but needed to collate evidence for
   • which standards they were not meeting.
2. Attending the respiratory team staff meeting enabled us to meet everyone and build up a rapport as trusted clinicians.  By really understanding the challenges that they faced we were able to provide innovative ideas and opportunities of how they could do things differently. 
3. We developed their annual staff survey, distributed it to the whole team, and provided anonymised analysis of results which were fed back at the team away day.
4. Organised and facilitated an interactive off-site annual review away day to enable everyone to have time and space to focus on:
• connecting, reflecting, learning, and developing
• work towards PRSAS accreditation
• complete annual review and develop operational plan for the year ahead
• become clearer about: what they do well, what they need to improve, and what they need to do now and next.

The SCW team, as registered physiotherapists, were able to bring a ‘fresh pair of eyes’, new perspective, and clinical insight to check and challenge and widen the scope considered for change. 

Outcome 

 Gloucestershire felt they now had a clear vision for their PR service. SCW provided clear outputs from the annual review away day and supported the PR team to develop their operational plan for the year ahead. These were major milestones in the accreditation journey. SCW provided the annual review away day slides as a template for the team to complete future annual events. 

SCW provided a useful overview of the service to all the team to ensure everyone understood the challenges and opportunities for the service. This included: 

• referral numbers and expected trajectory for the year ahead
• current waiting lists
• workforce challenges
• national and local audit data (review of NRAP run charts and KPI audits)
• patient/ carer feedback 
• staff annual survey results.

SCW also provided simple quality improvement (QI) information on how to undertake a PDSA cycle. The team were able to take stock of their achievements to date and make SMART action plans for improvement which were then prioritised. 

Bringing the team together provided a collaborative environment where everyone took ownership of developing the service as a team whilst taking on individual QI projects.

                                                                  Developing individual QI projects                                                                                                 Prioritisation of actions 

The away day started the conversation and encouraged collaborative thinking around how they could make service improvements as a team in pursuit of their vision. Individual QI projects are now in place which will ensure that all the team feel that they are having an impact on improving the quality of the PR service. SCW are hoping to support them with the next stage in their accreditation journey.

Click to read the Cancer and Long Term Conditions team's blog on this piece of work.