On Goldilocks, care coordination, and palliative care: making it 'just right'.

data will be linked across the three audit work streams and will be analysed centrally. Reports with benchmarking against the national average will be provided for all participating practices, with higher level reports for commissioners and other organisations at a regional and national level. The practice reports will offer support for standardised coding of records and service improvement. Changes will be measured in repeat audit cycles. Whilst the collection of this database in England and Wales is itself a massive undertaking, the learning from Finland is that this is merely the beginning of a 5-year quality improvement programme. Within secondary care a peer review initiative is one option to drive improvements in care. For pulmonary rehabilitation programmes, an accreditation process is proposed which could drive up standards and assist commissioning of rehabilitation. One of the underlying principles of all such national audits is the open publication of data. This may be used to help patients and commissioners to understand the quality of services available. The Swedish and Finnish National studies have shown what can be accomplished if a national effort is made to collect good quality data and to use those data to support clinicians in improving the quality of care delivered to COPD patients. We now plan to collect a much bigger dataset in England and Wales and use this to drive a multi-faceted quality improvement programme on the care of our COPD patients. This is an opportunity for clinicians to deliver a long overdue UK national health improvement programme on a grand scale for a previously neglected group of people.