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GPs should fund nurse COPD training

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GPs should fund training for practice nurses to deliver the national chronic obstructive pulmonary disease strategy, according to a leading health educator.

The long awaited national strategy for COPD, published in draft by the Department of Health last week, makes recommendations for preventing COPD, early diagnosis and treatment of the disease, and better self-management.

Education for Health chief executive Monica Fletcher, whose organisation trains nurses how to care for patients with respiratory disease, said primary care nurses would be instrumental in delivering the strategy but need to develop the right skills – for example accurate spirometry testing, understanding disease progression and training in smoking cessation.

A survey by the charity of 368 practice nurses involved in COPD care in 2006, found less than half of those nurses with advanced roles – such as diagnosing the disease and conducting follow-up consultations – had any accredited COPD training and only 8 per cent had accredited spirometry training.

Ms Fletcher said that if practice nurses received the right training it would “really help deliver this strategy in the long run”.

She said: “Managing COPD patients properly from the beginning can divert a lot of hospital admissions, and managing the disease in the community is far cheaper than in hospital.”

Ms Fletcher agues that GPs should pay for COPD training because of the contribution that nurses make to the quality and outcomes framework. “Practice nurses take on many tasks to help meet QOF targets, so GPs should ensure they have the appropriate, accredited training,” said told Nursing Times.

“This should be funded by the GPs that employ the nurses. If not, primary care trusts should negotiate funding for nurse training with strategic health authorities,” she added.

The Department of Health has invested £12m in developing and implementing the COPD strategy.

National clinical director for respiratory disease Sue Hill said no money has been earmarked for nurse training, but strategic health authority respiratory leads would look at how the existing money could be best spent to deliver the COPD strategy.

“Around £850 to £900m a year is spent on COPD in England. We need to look at how this money can be better utilised and reinvested to drive up quality and improve COPD services,” professor Hill told Nursing Times.

The consultation on the COPD strategy will close on 5 April. The final strategy is expected in the summer.


COPD strategy - core objectives

  • Identify people with COPD earlier in the course of the disease. Around two million people in England have undiagnosed COPD
  • Improve diagnosis for COPD. Many patients with COPD are misdiagnosed as having asthma.
  • Develop structured care appropriate to people’s needs, focusing on accurate and earlier diagnosis and the provision of structured care
  • Help people self manage the condition by way of structured exercise and education
  • Reduce the number of people admitted to hospital with COPD. Rates of admission vary up to five times in different parts of England
  • Address the poor prognosis for people with COPD - around 15 per cent of those admitted to hospital will die within three months and around one in four will die within a year of admission
  • Improve access to end-of-life care for people with COPD
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