This QI project is mandatory for GP practices across Wales, and can be broken down into the following simple steps:

Arrange an internal discussion to introduce this QI project to your team

Slides have been provided in the resources linked below, which will aid these internal discussions with the practice team. Ensure that this meeting is formally documented, as this will be required to submit as evidence towards the QIF QI Project.

Benchmark current inhaler prescribing for your practice (using the SPIRA dashboard)

The SPIRA dashboard is an online interactive programme for comparative analysis of prescribing data in NHS Wales. It provides data on an All Wales basis, by healthboard, by cluster, and by individual practice, and displays comparisons of DPI prescribing vs MDI prescribing allowing practices to benchmark and monitor their current inhaler prescribing. The dashboard is accessed via the AWTTC website: https://www.awttc.org/spira

• *NB the data provided has a 3-month lag (access in March 2023, will show prescribing data for December 2022)

Compare this to the NHS Wales target (80% DPI)

The NHS Wales Decarbonisation Strategic Delivery Plan has set a target shift to 80% of inhalers being low Global Warming Potential (GWP) alternatives by 2025.

Check your local health board for any additional incentives for this QI project

Many healthboards in Wales and created additional incentives for practices to complete this QI project.

Review and optimise asthma and COPD care for all patients, particularly focusing on high risk patients and high SABA users

According to the All Wales Asthma and COPD Management Guidelines, patients should be optimised using the highest value interventions.

Use dry powder inhalers or soft mist inhalers as first-line treatment options where clinically appropriate

Some patients might even have better disease control on dry-powder inhalers, due to the many pitfalls with inhaler technique and sub-optimal spacer use with MDIs.

Maintenance and Reliever Therapy is a regimen for Asthma where the same inhaler is used as a preventer (e.g. BD) AND reliever (prn). It contains Formoterol which is a fast-acting, long-acting beta-agonist (LABA) resulting in relief from asthma symptoms, and this relief is comparable to Salbutamol (1-3 mins). It also contains an ICS (budesonide or beclomethasone) which ensures the patient gets the anti-inflammatory benefits every time they use their inhaler. MART reduces the risk of exacerbations, and is useful to simplify the self-management and improve adherence, especially for people who are over-reliant on their SABA. And many inhalers licensed for MART are dry powder inhalers.

Submit to your health board

A template form has been provided below to help record the progress of completion of this QI project in your practice.