Making waves: spreading a life-changing model for informal COPD clinics

Can inviting someone along for coffee and bingo really transform the way they self manage their Chronic Obstructive Pulmonary Disease (COPD)?

Paul Dodd is confident that it can. He’s the project lead for Making Waves: RIPPLE 2, and the Respiratory Programme Specialist at South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group, which is hosting this innovative project. Delivered by West Midlands Respiratory Improvement Programme, RIPPLE 2 aims to spread a new model for COPD self-management support across six communities in England, with support from a Health Foundation Spreading Improvement grant.

‘The original RIPPLE 1 project has been going for 18 months now and we’ve seen amazing outcomes in terms of people’s ability to self-manage. We want this project to be a springboard in terms of a critical mass of spread,’ he says.

A ripple effect in the community

RIPPLE 1 ran in Coventry from 2014-15, bringing people with severe COPD together with clinicians at informal clinics. It proved highly successful in improving wellbeing and reducing the high levels of social isolation and anxiety often seen in people with COPD.

COPD is an umbrella term used to describe progressive lung diseases which make it difficult to breathe, including emphysema and chronic bronchitis. COPD is a major health problem, and a significant cause of premature death in England. It’s the second highest cause of emergency admissions to hospital and a very costly condition for the NHS to treat.  

Dr Colin Gelder is the Consultant Respiratory Physician for University Hospitals Coventry and Warwickshire NHS Trust, and the project’s clinical lead.

‘The most amazing differences we saw were in people’s wellbeing. One woman had been housebound for a year when she joined us. Following her progress at our clinics, she booked a holiday in Skegness, which went so well that she’s going back this year and taking her family.’

Community clinics

The innovation behind the RIPPLE model is that it takes consultations out of a clinical setting and combines them with social activities in a way that reduces isolation. Patients build a rapport with their doctor or nurse through regular relaxed interaction, while also meeting others with the same condition.

‘When we suggest meeting people for a coffee and a game of bingo at one of our informal clinics, it’s much more appealing than asking them to another appointment,’ explains Dr Gelder.

‘One man we worked with took three buses, without his oxygen, the first time he came. Attending our clinics transformed his life and gave him a new sense of positivity.’

‘People may come to our clinic because they were asked to by their clinician, but they keep coming back for themselves. They exchange phone numbers and build a network of contacts who can help each other stay connected and well. One woman got better to the extent that she started volunteering at the clinics. So the model is get better, and then start helping others.’   

Building a community of practice

The next phase, RIPPLE 2, has ambitious plans to engage an even bigger group of patients and practitioners and spread their community development approach.  ‘Ultimately we want to transform the care for people with severe COPD in Britain, moving the focus from drugs and tests to making people feel better,’ says Paul.

The team from RIPPLE 2 will be working with six sites in the East and West Midlands, each a group of health care organisations, such as GP consortia, Clinical Commissioning Groups, third sector organisations and NHS vanguard sites.

‘We’ve noticed that sometimes third sector organisations are better placed to carry out work in local communities, and they’ve been really useful in the spread of this project,’ says Paul, who has worked closely with the British Lung Foundation and local community groups since the project started.

‘Our model emphasises the positives and makes use of the assets that already exist within communities.’

Deeper investigation

Supported by Coventry University, robust academic evaluation is built in to the project. The people working on the project want to add to existing knowledge about successful self-management for those living with COPD, showing that it can be effective for patients from socially disadvantaged groups. They also want to investigate issues around patient anxiety, in particular how it prevents people from accessing certain treatments, such as smoking cessation. Dr Gelder adds, ‘Data suggests 40-60% of people with COPD also suffer from anxiety and depression. Yet some CCGs report that as low as 3% of people with COPD have these conditions, and we know thousands of people are missing from that data. We need a way to capture that information and ensure that those people can access a good quality of care that supports their mental wellbeing.’

The Warwick-Edinburgh Mental Wellbeing Scale will be used to measure success, as well as more traditional measurement including the number of GP and nurse visits, admissions and medication costs. ‘We need a better way to measure social inclusion, and it’s likely to be through qualitative analysis, involving narratives,’ says Paul. ‘We’d also like to measure the improvement in clinicians’ job satisfaction’.

From innovation to best practice

The team hopes to see further spread nationally, as the model becomes accepted and the evidence base builds.

‘We’re hoping each area we work with will be a beacon to fellow CCGs,’ says Paul. ‘National Clinical Respiratory Lead Professor Mike Morgan is very supportive of our work and we hope he’ll play a role in promoting this project at a national level.’

RIPPLE 1 was funded by our Shine 2014 grant programme. The team are now being supported by a Health Foundation Spreading Improvement grant to help them spread their work more widely.