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Gloucestershire Clinical Commissioning Group Joint Working Case Study

Improving asthma outcomes in Gloucestershire via consistent Advanced Inhaler Training

A Joint Working case study between Gloucester Clinical Commissioning Group (CCG) and Teva UK Limited

Download the Teva & NHS Joint Working case study

This is a case study of how Gloucestershire CCG worked in a local joint working initiative with the Project Group from Teva UK Limited to improve asthma outcomes in relevant practices.

Project rationale

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are long term conditions that feature prominently in Domain 2 of the NHS Outcomes Framework 2013/2014 and National COPD and Asthma Outcomes Strategy, Department of Health.

Locally in 2011, NHS Gloucestershire - now Gloucestershire Clinical Commissioning Group (CCG) - saw an increase in number of hospital admissions per patient and number of patients admitted for asthma ICD-10 codes.

The CCG project lead approached Teva UK Limited to determine if they would be interested in working collaboratively on rolling out the Advance Inhaler Training module that had been recently accredited by the WCCPE at Cardiff University, as it focuses on the importance of inhaler technique which they believed was vital in order to gain control of the increase in admissions related to asthma.

Gloucestershire then had around 41,000 diagnosed patients with asthma and around 10,000 diagnosed with COPD, spending approximately £14m annually on respiratory care. However, it was recognised that:

  • 50% of patients cannot use their inhalers correctly1
  • 60% of patients with poor inhaler technique are more likely to have exacerbations2
  • 91% of healthcare professionals who teach patients how to use inhalers could not demonstrate all the recognised steps involved in administering a Metered Dose Inhaler3

Gloucestershire CCG believed that having a number of accredited AIT trainers locally would have a positive effect on the integrated approach that they are aiming to achieve.

Through the formation of an asthma project group, there was a desire to run an AIT course to train 14 healthcare professionals (HCPs) from Gloucestershire CCG. These were made up of practice support pharmacists (PSPs) and practice nurses that had an interest in respiratory, along with secondary care respiratory pharmacists that had an interest in asthma.

Once the relevant HCPs had been trained and accredited via WCCPE, they were tasked with up-skilling other HCPs from the 86 practices, 113 community pharmacies and also the hospitals within Gloucestershire CCG.

The project aimed to improve respiratory care by raising the importance of device technique in a consistent and informed way with healthcare professionals and patients.

Desired Outcomes

Recognising this opportunity, the objectives of this joint working initiative in Gloucestershire CCG was to:

  • Ensure that the patients receive the highest level of asthma care within the primary care setting
  • Ensure that patients will have a greater insight into their disease through education and an improvement in the use of inhalers through checking inhaler technique
  • This will help address patient confidence and awareness of self-management plans, through education

Joint Working Initiative with Teva UK Limited

In order to achieve these outcomes, Gloucestershire CCG worked in collaboration with
Teva UK Limited as they provided:

  • Project management skills
  • Experience of delivering AIT with National Health Service (NHS) colleagues
  • A local Integrated Healthcare Manager and wider team to co-ordinate the initiative and be a source of contact for all stakeholders involved

Both Gloucestershire CCG and Teva UK Limited abided by the relevant regulatory bodies and guidance, including the ABPI Code of Practice and guidance.

Approach defined

The project was split into three distinct phases.


Outcomes achieved

The project succeeded in improving respiratory care by raising the importance of device technique in a consistent and informed way with healthcare professionals and patients.

(a) Over 900 healthcare professionals received Advanced Inhaler Training and consistent training around device technique

(b) Positive feedback was received from healthcare professionals of the Advanced Inhaler Training


Feedback was received from patients who participated

(c) Impact on hospital admissions and associated costs

Benefits of Joint Working with Teva UK Limited

This project demonstrated a successful collaborative approach to address a significant issue facing the local health economy. Factors beyond the scope of this project may have impacted on the project results achieved.


The project improved respiratory care by raising the importance of device technique in a consistent and informed way with healthcare professionals and patients.

Joint working between Teva UK Limited and the NHS must be for the benefit of patients or the NHS and preserve patient care.4

1. Restepo et al, Int of Chron Pulmon Dis 2008; 3(3): 371-384
2. Garcia-Aymerich et al, Eur Respir J 2000; 16: 1037-1042
3. Baverstock M, et al. Do Healthcare Professionals have sufficient knowledge of Inhaler Techniques in order to educate their patients effectively in their use? Thorax 2010;65:pA117[poster]
4. Department of Health. Best practice guidance for joint working between the NHS and the pharmaceutical industry, 1 February 2008