Systems for the management of respiratory disease in primary care - an international series: United Kingdom.
Prim Care Respir J. 2010 Nov 5. pii: pcrj-2010-05-0055-R1. doi: 10.4104/pcrj.2010.00070. Worth A, Pinnock H, Fletcher M, Hoskins G, Levy ML, Sheikh A. Allergy & Respiratory Research Group, Centre for Population Health Sciences: General Practice Section, The University of Edinburgh, Scotland.
INTRODUCTION: The UK National Health Service (NHS) is essentially publicly funded through general taxation. Challenges facing the NHS include the rise in prevalence of long-term conditions and financial pressures.
NATIONAL POLICY TRENDS: Political devolution within the UK has led to variations in the way services are organised and delivered between the four nations.
PRIMARY CARE RESPIRATORY SERVICES IN THE UK: Primary care is the first point of contact with services. Most respiratory conditions are managed here, including prevention, diagnosis, treatment and palliative care.
EPIDEMIOLOGY: Respiratory disease accounts for more primary care consultations than any other type of illness, with 24 million consultations annually.
ACCESS TO CARE: Equitable access to care is an ongoing challenge: telehealthcare is being tried as a possible solution for monitoring of asthma and COPD.
REFERRAL AND ACCESS TO SPECIALIST CARE: Referrals for specialist advice are usually to a secondary care respiratory physician, though respiratory General Practitioners with a Special Interest (GPwSIs) are an option in some localities.
CONCLUSIONS: Prevalence of asthma and COPD is high. Asthma services are predominantly nurse-led. Self-management strategies are widely promoted but poorly implemented. COPD is high on the policy agenda with a shift in focus to preventive lung health and longterm condition management.