Changes in the provision of home oxygen therapy

From February 2006, specialist teams will assess the oxygen requirements of patients before prescribing the most appropriate form of home oxygen therapy. Yvonne Henderson explains why these changes are necessary and outlines the anticipated benefits for patients and primary care trusts.

Home oxygen therapy is an expensive but necessary intervention. At a cost of £30 million annually (Royal College of Physicians, 1999), it is important that it is prescribed appropriately. There is evidence that a lack of specialist assessment results in unnecessary prescribing, in particular in the prescribing of oxygen cylinders, and that patient needs can be more effectively and economically met through a streamlined oxygen service (National Primary and Care Trust Development Programme, 2005).

In 2004, the Department of Health announced changes to the home oxygen therapy services in England, the aim being to co-ordinate and modernise the provision of home oxygen to patients (Department of Health, 2004). The changes were originally set to be implemented in October this year, but the date now set is February 2006. From then, the responsibilities of primary care trusts, hospital trusts and the strategic health authorities for the supply of oxygen will change significantly.

Current service provision
Currently, service provision of home oxygen therapy is complex and inconsistent between different geographical areas. For example, there is considerable variability between prescribing habits and adherence to current guidelines, and a lack of formal assessment, organised follow-up and monitoring arrangements (DoH, 2005a). At present, GPs prescribe home oxygen therapy, although it is argued that they are not necessarily the health professionals best-placed to do this because of the complex needs of patients requiring oxygen therapy (National Primary and Care Trust Development Programme, 2005). These patients are often managed by specialists in secondary care, but their oxygen is prescribed in primary care.

Various forms of home oxygen therapy are available, each with its own particular prescribing criteria. Thus, oxygen cylinders are prescribed by the GP and supplied by the community pharmacists, who arrange for them to be delivered directly to the patient's home. On the other hand, long-term oxygen therapy, which is delivered via a concentrator, is prescribed by the GP but installed and maintained by an external specialist contractor. Finally, ambulatory oxygen is not available on prescription but is provided at the discretion of the local primary care trust.

Changes in service provision from February 2006
From February 2006, specialist teams will assess the oxygen requirements of patients (DoH, 2004). Using their expertise, members of the teams will then prescribe the most appropriate form of home oxygen therapy. GPs will retain the right to prescribe, but it is envisaged that they will be more likely to refer on to the specialist team or prescribe oxygen for short-term use as, for example, in palliative care.

In total there will be 10 home oxygen service regions in England and, following competitive tender, four companies have won five-year contracts to supply these regions (DoH, 2005b). The companies are:

- Air Products;

- Allied Oxycare/Medigas;

- British Oxygen Company;

- Linde.

The contractors are expected to provide a one-stop service for patients, clinicians and primary care trusts, with streamlined supply and funding routes. They will provide an integrated service for cylinder, concentrator and ambulatory oxygen. This contract framework will be more cost-effective than the previous system, and it is anticipated that it will improve patient care.

Responsibilities of primary care trusts
To bring about the change, primary care trusts will need to take on particular responsibilities:

- Work with stakeholders (patients, carers, GPs, current oxygen service providers, community pharmacists and oxygen contractors), and new providers (hospital trusts and new contractors) to develop local arrangements for managing change;

- Discuss arrangements for assessing and prescribing home oxygen therapy, including the transfer of essential patient information to the new contractor, to ensure continuity of care;

- Establish systems for funding and contract management.

The new guidelines will come into force from February 2006, with a nine-month transitional period. It is imperative that primary care trusts begin to plan for change as a matter of urgency, as it estimated that each new contractor will require eight months to put in place all of the systems necessary to enable the new service provision (National Primary and Care Trust Development Programme, 2005). The benefits to the trust and to patients are listed in Boxes 1 and 2.

Conclusion
Integrated home oxygen therapy services provided by contractors to 10 different oxygen therapy regions are now being established across the country. To ensure a consistent approach to service delivery, the changes should be overseen by the relevant strategic health authority. There is a very tight timetable, and the engagement and involvement of the primary care trust to lead and manage change locally is critical to the success or failure of the service.

Nurses have a particular role to play in the new service, either as part of the specialist team responsible for assessing and monitoring patients' oxygen requirements or as a driving force behind preparing the primary care trusts for change. It will be the responsibility of all health professionals to ensure that they are familiar with the new guidelines and aware of the implications these will have on clinical practice. An awarenesss of the referral criteria and pathways will be essential.

Further information
See the BTS website: www.brit-thoracic.org.uk

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