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NHS Bristol Joint Working Case Study

Reducing asthma hospital admissions across NHS Bristol

A Joint Working case study between NHS Bristol and Teva UK Limited

Download the joint working case study

Project rationale

NHS Bristol identified there were 79,794 emergency hospital admissions for asthma in the UK in 2008-09 with an estimated 75% being avoidable.1 During that time, around 600 people were admitted to hospital as a result of their asthma, with four deaths in Bristol alone.

NHS Bristol wanted to improve asthma management to reduce asthma hospital admissions.

Local challenge

Previous audits had identified:

  • Variations in asthma management across GP practices with some practices providing annual asthma reviews to 73.3% of their asthma register, and others only 36.4%;
  • Variation in admissions of between 0.2% and 6.9% of the asthma register;
  • On average, only 20.8% of asthma patients have been provided with an asthma self-management plan (SMP). If patients were better informed on how to manage their asthma symptoms, it is likely that many of these admissions could have been prevented;
  • Exception reporting data for Quality and Outcomes Framework Asthma highlighted that as much as 38.3% of asthmatics in some practices were being exception reported rather than reviewed.

Agreed objectives

The objectives for the project were aligned to QIPP:

Resource split

Outcomes achieved

Reduction in hospital admissions

There was a 19.46% reduction in asthma admissions in 2011/12 in Bristol (n=56) compared to the previous year. Practices participating in the IMPACT programme accounted for 54.7% of this (n=13).

Positive patient reported outcomes

Results from the IMPACT service patient evaluation showed that patients felt more confident in managing their asthma and that they were using their inhalers correctly following a structured asthma review.

Question (‘Strongly agree’ or ‘Agree’)

  • I would recommend this asthma review to others - 96%
  • I will attend a yearly asthma review at my surgery - 95%
  • I am very satisfied with the asthma review I received - 98%
  • I am more confident in managing my asthma - 93%
  • I know what to do if my asthma gets worse - 97%
  • I now feel confident that I can use my inhalers correctly - 95%
  • I now know more about my asthma - 85%
  • During the review I was allowed to say everything that I thought was important - 99%
  • The asthma review was useful - 95%

In alignment with QIPP, NHS Bristol succeeded in improving asthma management to reduce (prevent) asthma hospital admissions. Benefits included:

Other NHS organisations have expressed an interest in the success of this project and discussions have taken place regarding replication and implementation between interested parties.

Joint Working between Teva UK Limited and the NHS must be for the benefit of patients or the NHS and preserve patient care.8

1. Asthma UK for Journalists: Key facts and stats: www.asthma.uk.org (Viewed June 2012). 

2. Thorax 2008; 63(Supplement 4):iv1- iv121. [Accessed June 2012] Available from: http://dx.doi.org/http://www.sign.ac.uk/guidelines/ fulltext/101/index.html. 

3. Nursing and Midwifery Council. Standards of conduct, performance and ethics for nurses and midwives. [Last Accessed: June 2012]; Available from: http://www.nmc-uk.org/aArticle.aspx?ArticleID=3056. 

4. The Association of the British Pharmaceutical Industry (ABPI) Code of Practice (2012).[Last Accessed: June 2012]; Available from: http://www.abpi.org.uk/publications/pdfs/pmpca_code2011.pdf. 

5. The Caldicott Committee. Report on the Review of Patient-Identifiable Information. 1997 [Last Accessed: May 2012]; Available from: http://www.wales.nhs.uk/sites3/Documents/783/ DH%5F4068404%5B1%5D.pdf. 

6. UK Data Protection Act. 1998 [Last Accessed: June 2012]; Available from: http://www.opsi.gov.uk/acts/acts1998/ukpga_19980029_en_1. 

7. http://www.nelm.nhs.uk/en/NeLM-Area/News/2011---August/09/ New-Steering-Group-set-up-to-tackle-medicines-wastage-in-the-NHS/. 

8. Department of Health. Best practice guidance for Joint Working between the NHS and the pharmaceutical industry, 1 February 2008.