Breakout 2.1 Huntingdon integrated sleep studies service - Dr Malav Bhimpuria – GP Principal , Huntingdon
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
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Dr Malav Bhimpuria's Integrated Sleep Studies Service
1. Dr Malav Bhimpuria – GP Principal , Huntingdon.
Hunts Care Partners
INTEGRATED SLEEP STUDIES
SERVICE
• Obstructive Sleep Apnoea
Syndrome (OSAS) is common (1%
men in UK, up to 30% of obese).
• Incidence increasing, awareness
and referrals increasing too.
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2. INTEGRATED SLEEP STUDIES
SERVICE
Up to 23% of men with T2DM have it.
NICE estimate up to 1 million people
with undiagnosed OSAS to varying
degrees.
Risks associated with driving.
Cardiovascular risk also: associated with
obesity, DM, hypertension, ACS, heart
failure, AF and the metabolic syndrome.
Hunts Care Partners
INTEGRATED SLEEP STUDIES
SERVICE
Recent evidence (e.g. Lancet 2009; 337: 82) suggests a
direct association between OSAS and CV risk.
Repetitive hypoxic state activates the sympathetic
nervous system and raises blood pressure, heart rate
and CV stress.
Impaired vascular endothelial function and platelet
activation.
Moreover, treatment ameliorates the risk.
BJGP 2010:60; 235: CPAP improves BP control and
sleepiness scores.
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3. INTEGRATED SLEEP STUDIES
SERVICE
HOW DIAGNOSED?
GP suspects, patient referred to Sleep Centre (usually
Papworth Hospital).
Gold standard service.
Alconbury and Brampton Surgeries....doing
something different.
National recognition: GP Enterprise Awards for
Innovative Clinical Care 2011, “Practical
Commissioning”, Worcestershire CCG, Lincs, London,
Enfield, Hounslow, Isle of Man.
Local recognition.
Hunts Care Partners
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4. INTEGRATED SLEEP STUDIES SERVICE
• August 2009: Alconbury and Brampton introduced a
near patient pulse oximetry service to support the
diagnosis of sleep apnoea (OSA).
• “Triple lock”: clinical assessment, Epworth scores
and overnight pulse oximetry.
• The use of this technology reduced the number of
OPFAs at Papworth in year 1 by 60% (20 were tested
and of these 8 were then referred to Papworth) and
93% in year 2 (28 were tested and of these only 2 were
referred).
• People started to notice....
Hunts Care Partners
INTEGRATED SLEEP STUDIES SERVICE
THE AIM: “an innovative, patient- centred,
integrated sleep studies service across
traditional primary and secondary care
boundaries”.
A hub (Papworth Hospital), spoke (each
market town: Huntingdon, St Neots, St Ives,
March, Ramsey) and satellite (other GP
surgeries ) service .
Governance & booking provided by Papworth.
Initially for new patients, eventually follow-ups
and then farther a field.
Showcase for the country.
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5. INTEGRATED SLEEP STUDIES SERVICE
• Tariff unbundled: savings for local health
economy.
• Local incentive for the spoke practices (no new
work for no new money).
• Satellite surgeries have no increased workload.
• Training in primary care for spokes.
• Greater awareness across all primary care.
• Fewer patient journeys and care closer to home.
• Joint working between local commissioners,
primary and secondary care.
• Involvement of voluntary organisations (BLF).
Hunts Care Partners
INTEGRATED SLEEP STUDIES
SERVICE
RESULTS SO FAR....
All five spokes up and running since May 2012.
Data to December end shows 138 community sleep
studies were undertaken.
Of these, 43 (32%) had NO further secondary care
input. A further 6 were booked directly for in-pt rx.
Savings to the local health economy.
Rapid diagnosis, local environment, proved it works!
National awareness.
Dept of Health and also B.L.F.
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6. Any Questions?
Dr Malav Bhimpuria MB BS BSC (HONS) FRCGP
DCH DRCOG PG Cert
GP Principal.
Hunts Care Partners
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