The PCT took part in the first PBC development programme. Leads from five GP practices, the PEC chair and the Local Medical Committee representative were part of the team that attended all three IF workshops along with the PBC team at the PCT. This enabled the spread of good practice across the PCT and supported the development of business cases for service redesign.

Through sharing ideas and making links with the other PBC sites, the team was able to start structuring the PBC agenda for Barking and Dagenham. Service redesign areas were developed from what was learned at the workshops.

Working together, the team agreed the PBC framework for 2007-08, financial management and budgets, service redesign, Local Development Plan priorities, and decided the level and quantity of patient level data that is provided to practices on a monthly basis.

In order to improve care for COPD patients, they recruited additional health professionals to the community team: a full-time consultant physician, a full-time clinical psychologist and a part-time assistant nurse practitioner .

In December 2007 the PCT reviewed the community COPD service and found the improvements had brought about a significant reduction in emergency admissions and outpatient flows into the acute hospital. They had also generated £298,000 of savings over six months.

• Emergency admissions: Where COPD is the primary diagnosis, the total number of admissions in 2007-08 showed a percentage drop of 30.4% compared with 2005-06. Admissions where COPD is mentioned, but is not the primary diagnosis, showed a drop of 13.8%.
• Diversion of outpatient flows: The percentage reduction in general medical first outpatient appointments was 35.1% compared with 2005-06. The percentage reduction in general medical follow-up appointments was 12.1% compared with 2005-06.