Behind the scenes Day in the life
Claire Broussine, Primary Care Practitioner based at Hartcliffe Health Centre
In a nutshell
“I work closely with GP surgeries and visit their patients in the home early in the day. I look for and treat acute illness and chronic conditions which are getting worse, and I put practical things in place to stop the patient being admitted to hospital that day. This also frees up the time of GPs so they can focus on patients with the most complex needs.”
Early bird First thing in the morning I review my home visits for the day and prepare by looking at the patient's medical background. I also find out how my previous patients are doing, particularly if there was a hospital admission or I have referred them to other clinicians, like our falls assessment team. I always find the input of other clinicians really valuable and a great learning experience for me. I complete any admin along with any less urgent referrals from the previous day. Then I’ll have a pre-visit discussion with one of the GPs, where they’ll give some valuable insight into what they think the problem is, what they want me to assess for, any particular things to be aware of, and also what they already know about the patient. I used to be a paramedic, normally only
seeing patients on a one-off basis, so it’s fascinating to work with GPs who have built a professional relationship and have real insight into a patient they may have known for years.
long-term conditions like lung disease and dementia – and I often review people who have recently fallen. But I can see a huge range of conditions, including complex social care cases, pelvic fractures, depression, anxiety, On the rounds psychosis, and many others. Then I’ll go on my visits, and usually By identifying these conditions early see about in the day and four patients putting the a day. Nearly patient on the all of these right medication patients are and getting the housebound, right clinical and often quite support, I think frail. I frequently this definitely see issues like reduces the chest infections likelihood and urine of hospital infections, along admission. Pre-visit discussions with Dr Gareth with worsening While I’ve Ronson from the Lennard Surgery symptoms of been in this role
Top tips for living with COPD • Take your prescribed medication, including inhalers, as this can help control your breathing and prevent flare-ups. Read the information that comes with your medication to help you understand about possible interactions with other medicines or supplements.
Under the microscope
Community Respiratory Team Who? Team of dedicated healthcare professionals supporting people with chronic respiratory conditions, including chronic obstructive pulmonary disease (COPD). Treats patients at home to prevent unnecessary admission to hospital and helps people get home from hospital earlier. Provides a treatment programme with personalised exercises and education to help patients understand and manage their own condition (known as pulmonary rehabilitation). Also assesses patients who might need to use oxygen at home. What’s COPD? A group of lung conditions that cause breathing difficulties, which includes emphysema (damage to the air sacs in the lungs) and chronic bronchitis (long-term inflammation of the airways). It’s a common condition caused by longterm damage to lungs from breathing a harmful substance, usually cigarette smoke. It mainly affects middle-aged
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or older adults. Breathing problems tend to get gradually worse over time and can limit normal activities, although treatment can help keep the condition under control. Symptoms can get worse in colder months. Why? Many people don’t realise they have COPD. 17,000 local people have been diagnosed but it’s estimated that this is half the number of people who actually have the disease. Bristol is a COPD hotspot, possibly because of a strong history of maritime and industrial trade and the tobacco industry. To get COPD support from the team at home you’ll need to be referred by a healthcare professional, but you can refer yourself to the pulmonary rehab programme by calling 0117 961 7159 if you have a chronic respiratory condition. Visit briscomhealth.org.uk/our-services/copd.
• Stop smoking to help slow down or prevent further damage to your lungs. Speak to your GP for advice or visit nhs.uk/livewell. • Exercise regularly. How much you do will depend on your individual circumstances. Speak to your GP for advice before starting a new exercise programme. • Maintain a healthy weight. Carrying extra weight can make breathlessness worse. Lose weight through a combination of regular exercise and a healthy diet. If you’re losing too much weight because eating makes you feel breathless, try to eat little and often. Speak to your GP or nurse about being referred to local dietician services. • Get vaccinated. COPD can make you more vulnerable to infections. Everyone with COPD is encouraged to have the annual flu jab and the one-off pneumococcal vaccination. You can get these at your GP surgery and some local pharmacies.
• Check the weather. Cold and hot weather and humidity can cause breathing problems if you have COPD. Keep an eye on the weather forecast and make sure you have enough of your medication in case your symptoms get temporarily worse. • Practise breathing techniques. These include breathing control, which involves breathing gently using the least effort, with the shoulders supported. Learn more at blf.org.uk. • Talk to others. Your GP or nurse may be able to reassure you, or you may find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have information about these. Some people find it helpful to talk to others who have COPD, either at a local support group or on the internet. Get more info at blf.org.uk. For more information and support, visit nhs. uk or blf.org.uk/ support-for-you/ copd.