Overview

This is system-wide, digital-first approach to supporting patients with COPD who are at high risk of a hospital admission, particularly during winter. The approach, through a companion app, monitoring support, encouragement and personalised care helps patients live well with their conditions.

One Care has successfully promoted the views and involvement of general practice and has:

• ensured GP clinical input into the planning and delivery of the project
• secured funding for all practices for the additional work required
• ensured COPD nurses can review patient lists before patients are contacted
• provided templates for communications to patients

The project aims to ease the pressure on general practice, community support, and hospital services, and will help improve the wellbeing of thousands of patients. It is a partnership project with the NHS in BNSSG; Sirona care & health; One Care; Doccla, who provides the home monitoring service; and mymhealth who provides the dedicated COPD support app called myCOPD. The 2024 project may continue in future if it’s successful.