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How one social enterprise has transformed respiratory care

Melissa Canavan took the risky step of leaving her job to set up a new business
Melissa Canavan & Sarah Anderson

Leaving her job to set up a social enterprise has proven a great success for a practice nurse's personal work-life balance as well as her patients

Melissa Canavan and Sarah Anderson

Practice nurse Melissa Canavan was at a public health meeting discussing potential improvements to respiratory care in Leeds when a commissioner said to her: I wish you were a company as we could give you some money to do these things.

This comment started a journey that led to Ms Canavan and fellow practice nurse Sarah Anderson setting up a social enterprise to work with local GP practices on improving the quality of lung care in the Yorkshire city.

Ms Canavan now works with up to 12 practices in an inner city area seeing patients clinically, leading audits and providing training for nurses

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Leaving her job to set up a social enterprise has proven a great success for a practice nurse's personal work-life balance as well as her patients

Melissa Canavan and Sarah Anderson

Practice nurse Melissa Canavan was at a public health meeting discussing potential improvements to respiratory care in Leeds when a commissioner said to her: ‘I wish you were a company as we could give you some money to do these things.’

This comment started a journey that led to Ms Canavan and fellow practice nurse Sarah Anderson setting up a social enterprise to work with local GP practices on improving the quality of lung care in the Yorkshire city.

Ms Canavan now works with up to 12 practices in an inner city area seeing patients clinically, leading audits and providing training for nurses and other staff.

Improving respiratory outcomes by educating staff and patients

When they started the social enterprise, called Respiratory Care Solutions, in 2015, Leeds was one of the worst areas in the country for respiratory outcomes according to the 2012 NHS Atlas of Variation in Healthcare for People with Respiratory Disease. ‘We wanted to change this through education for staff and patients,’ says Ms Canavan.

Ms Canavan started her nursing career as a nursing cadet at her local hospital. She took her nursing degree at the University of Leeds over five years, as she had two children, and spent a year working in an emergency department.

She then went to work as a practice nurse for the next nine years. ‘I went to a little surgery where I was the only practice nurse, and it was a big culture shock.’

Variation in primary healthcare

She and Ms Anderson, who she met on the first day of her nursing course, set up the Leeds respiratory network, affiliated with the Primary Care Respiratory Society, and started organising local education events for nurses and doctors.

At this point they realised the full scale of need for improvement, particularly for patients with asthma and chronic obstructive pulmonary disorder.

'There was so much variation in the care provided... Some practices saw reviews as a tick-box exercise'

Melissa Canavan

Their realisation led to the fateful public health meeting, where Ms Canavan and Ms Anderson discussed the need for funding to improve education for primary healthcare staff and patients to standardise care.

‘There was so much variation in the care provided,’ Ms Canavan says. ‘You think there is a strategy, so everyone will get the same approach, but some practice nurses were getting ten minutes for an asthma review, and some were getting 30 minutes. Some made sure they got some training, some did not. Some practices just saw reviews as a tick-box exercise.’

Working together to standardise care and reducing variation

After setting up the organisation Ms Canavan left her job as a practice nurse for a 12-month contract at Leeds Teaching Hospitals NHS Trust respiratory day unit, hoping that the business could secure a contract. A contract then came from an inner city group of GP centres, now a Primary Care Network (PCN), that believed in the organisation and wanted to work with them to standardise care and reduce variation.

Ms Canavan could now focus solely on her work in the social enterprise. She delivers respiratory updates and joint clinics, supporting nurses through diplomas and virtual reviews. She has also worked with local schools and community pharmacies to standardise messages. Ms Canavan and Ms Anderson, who has since left the NHS [but still works in the social enterprise], became lead nurses for the PCN in Leeds.

Improved care for people with lung conditions

Within 18 months they had saved more than £220,000 in respiratory prescribing costs. While measuring change has been difficult, due to the lack of follow-up data, many patients tell them how valuable they found their annual review with the pair, and how it has improved their management and quality of life.

Ms Canavan says starting the social enterprise has improved care for people with lung conditions, and improved her work-life balance and income. But the step has not been without risk, and has been challenging. ‘There is a lot to get to grips with on the financial side when you start a business, fortunately Sarah has always been good at that aspect.’

‘There have been some knock-backs and obstacles, you have to persevere if you set up a social enterprise,’ Ms Canavan says. ‘But I love it. I can manage my working week, I have better job satisfaction, and I feel we have improved the quality of life of many people with lung conditions.’

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