Background: Pulmonary rehabilitation (PR), a programme of exercise, education and psycho-social support, is recommended for patients with chronic obstructive pulmonary disease but referral rates are relatively low compared with need. Aim: Working with primary care clinicians (GPs and practice nurses) from eight practices, this project developed strategies for influencing clinician and patient behaviours as a means of increasing referral rates for PR. Methods: A participatory action research design was employed. Semi-structured questionnaires captured clinicians' baseline knowledge of PR and their ideas for increasing referrals. Actionable changes were then recommended. Audits (at baseline, mid-point and end of project) were used to assess and initiate improvements in the quality of practice data about PR referrals. The impacts of these changes were explored via further clinician surveys (free text questionnaire). Semi-structured questionnaires, posted to patients eligible for PR, assessed their characteristics, and, where applicable, their views on PR referral processes and reasons for not wanting PR. Findings: The baseline survey of clinicians (n = 22) revealed inadequate knowledge about PR, particularly among GPs. Actionable changes recommended included in-house education sessions, changes to practice protocols, and 'pop-ups' and memory aids (mugs and coasters) to prompt clinician/patient discussions about PR. Audit findings resulted in changes to improve the quality and availability of coded information about patients eligible for PR. These changes, supported by clinicians (n = 9) in the follow-up survey, aimed to facilitate and increase the quality of patient/ clinician discussions about PR. Findings from the patient survey (n = 126, response rate 25.7%) indicate that such changes will increase the uptake of PR as patients who accepted a referral for PR provided more positive feedback about their discussions with clinicians. Conclusions: The strategies introduced were relatively easy to implement and the anticipated advantage is more patients accessing the health and quality of life benefits that PR offers.

Long term conditions such as COPD have long term implications for the daily lives of patients and their carers. Hearing about these consequences in 'the first person' is an influential training tool with a powerful impact on PHCPs' attitudes and behaviour.

ObjectivesTo compare our clinical practice against the NICE quality standards for children’s epilepsy service.MethodsOutpatient clinic lists for consultant specialist in diagnosis and management of epilepsy were obtained for one year (April 2016 – May 2017) and outpatient letters were reviewed. All patients diagnosed with epilepsy within the last ten years were included. Patients diagnosed abroad or at another hospital were excluded.ResultsA total of 119 patients were audited; 65 male and 54 female.Seen by specialist in the diagnosis and management of epilepsy within 2 weeks of presentation with a suspected seizure? Yes=33, No=86Investigations (MRI/EEG) undertaken within 4 weeks of request? Yes=66, No=53Children meeting criteria for neuroimaging have an MRI? Yes=69, No=4, N/A=46Agreed and comprehensive written epilepsy plan? Yes=116, No=3Patients seen by epilepsy specialist nurse? No=115, N/A=4Agreed written emergency care plan for prolonged/repeated seizures? Yes=14, No=63, N/A=42Seen within 4 weeks of referral to tertiary centre if required? Yes=6, No=17, N/A=96Structured review with paediatric epilepsy specialist minimum annually? Yes=107, No=1, N/A=11Agreed transition period where care reviewed jointly by adult and paediatric services? Yes=14, No=5, N/A=100ConclusionsThe results highlight our patients are having comprehensive written care plans (97%), structured reviews annually (99%) and are reviewed jointly for transition (74%). Epilepsy service enhancement is needed in the time taken to be seen by the secondary care epilepsy specialist (28%) or tertiary centre (26%) once a referral is a made. Investigation time waits could also be improved (55%). Quality of care could be enriched by employing an epilepsy nurse specialist.Numerous studies have demonstrated that inadequate epilepsy care results in significant consequence. It is imperative to implement NICE quality standards to provide better quality of care to children/young people diagnosed with epilepsy.

Introduction: Evidence based care for COPD involves patients obtaining timely access to an integrated network of evidence based services delivered by staff with different skills working across different settings. Patient needs for these different services can vary over time as the status of their condition changes or they suffer sudden health crises. The primary care team (GPs and practice nurses) have a key role as a provider of and referrer to care but their awareness and use of evidence based care has been questioned [1]. This paper describes the nature and impacts of an innovative training programme that aimed to improve the quality and integration of care by increasing the primary care team's awareness and use of needed services.