BNSSG Healthier Together

Digital solution offering vital support for local people with COPD


Thousands of people with chronic obstructive pulmonary disease (COPD) are able to benefit from a digital scheme launched to provide more support at home.

COPD is the name for a group of lung conditions that cause breathing difficulties. It’s responsible for around 115,000 emergency hospital admissions in the UK. This is equivalent to more than one million bed days.

Living Well with COPD has been launched by Healthier Together, the Integrated Care System in Bristol, North Somerset and South Gloucestershire, to support people with COPD.

Professor Sanjoy Shah, Deputy Chief Medical Officer at North Bristol NHS Trust and Clinical Lead for the Living Well with COPD programme, said:

“Each winter, especially when temperatures are low, a large proportion of people are admitted to hospital for care related to COPD. In many cases, these admissions could be avoided with closer monitoring and preventative medical interventions taken earlier.

“Living Well with COPD aims to provide a solution to this, by both empowering local COPD sufferers to take better control of their health through improved education on their condition and how to best manage it, as well as closer monitoring and the ability for specialist community clinicians to provide much earlier interventions.

“The aim of the service is to keep people well at home at the same time as reducing the pressure on our GP services and busy local hospitals.”

Living Well with COPD is a pilot programme designed to enable up to 9,500 people with COPD to take greater control over their health and stay well at home. It is amongst the first few services in the country to combine remote monitoring with health coaching alongside supporting and preventative care.

The programme provides digitally enabled care using specialist applications and remote monitoring equipment to empower people with COPD to take control of their health, while reducing calls to GP practices and admissions into local hospitals.

The programme is providing four tiers of support to local people with COPD:

  • Tiers one and two are for people with milder disease. Up to 9,000 people can be supported using my mhealth’s myCOPD app, and also the myHeart app (if they also have cardiovascular disease).
  • Tier three is for people at a higher risk of hospital admission. Around 165 people can be provided with equipment to enable digital monitoring from home. This will be overseen by clinical staff from Doccla, along with health coaches providing virtual support to help people manage their condition at home, in addition to the My mhealth apps.
  • Tier four is for people whose COPD condition means they are most at-risk of deterioration and a hospital admission. Around 150 people can be supported by specialist clinicians at Sirona care & health who will be able to closely monitor people through the digital technology and provide face-to-face interventions to keep people well at home.

Richard from Bristol, who is in his 70s and lives with COPD, said:

“I’ve had a lot more input since I’ve signed on. I was told that nothing more could be done for me. I was feeling a bit abandoned. Now I feel a lot better. I’m very grateful. My partner said it’s amazing what I’ve been given.”

Anyone living with COPD who is registered to a GP practice in Bristol, North Somerset and South Gloucestershire is eligible for support through the myCOPD and myHeart apps (depending on diagnosis). People have been identified by One Care, the GP Federation, and their GP Practice and are being contacted.

Eligible people can also register through an online form.

Eligible people with more severe COPD will receive a text inviting them to take up the option of the extra support.