Dr. Malav Bhimpuria discusses the increasing prevalence and risks associated with obstructive sleep apnoea syndrome (OSAS) and the innovative diagnostic approach implemented by Huntingdon's care partners. The introduction of a near patient pulse oximetry service significantly reduced referrals to secondary care while establishing a patient-centered integrated sleep studies service across primary and secondary care. Results indicate that this initiative has improved local health outcomes and garnered national recognition.

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.
Hunts Care Partners
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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.
Hunts Care Partners
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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
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.
Hunts Care Partners
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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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