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Winter warning as '35,000' respiratory diagnoses 'delayed due to pandemic'

Patients with respiratory disease have been overlooked during the Covid-19 pandemic, with the NHS storing up problems for the winter months, a group of experts including the RCGP has warned.

Analysis by the 34-member Taskforce for Lung Health showed that referrals for lung conditions fell by 70% in April, with two-in-five (39%) of CCGs seeing no appointment bookings for respiratory conditions for the whole of May.

On average, the group calculated a weekly average of 3,399 lung patients missing out on urgent and routine referrals during the Covid-19 lockdown, amounting to a total of at least 34,780 people, based on NHS England data.

This was blamed in part on a general reduction in routine procedures during the pandemic, which will have affected all disease areas, but also the limitations on clinicians including GPs to carry out spirometry due to the risk of Covid-19 infection spread.

But the taskforce - which includes the RCGP and the Primary Care Respiratory Society, as well as the Royal College of Physicians and Asthma UK - is now calling on NHS England to urgently restore services to pre-pandemic levels to tackle the backlog of lung patients requiring support.

It said that failure to do so risked causing the premature death of patients who require urgent diagnosis as well as overwhelming the NHS during the winter season, when respiratory symptoms worsen.

The Taskforce for Lung Health said: 'Hospital admissions due to respiratory conditions are one of the greatest contributors to winter pressures faced by the NHS. The recent delays in diagnosis and care will likely severely impact people whose lung conditions have become unmanageable, or those who will continue to live without diagnosis or treatment to keep their condition under control.

'On top of ordinary annual spikes for respiratory, this will lead to an overwhelming backlog of people needing urgent treatment in hospitals this winter. The Taskforce for Lung Health is calling for NHS England to ensure that services are back up and running as soon as possible in order to tackle this backlog of patients needing support.'

London GP Dr Noel Baxter, policy lead at the Primary Care Respiratory Society, suggested patients should be encouraged to come forward with lung problems at this time.

He said: 'It’s possible that people who may have had symptoms of a lung condition – such as breathlessness – for some time, may have become more aware of them because we are now so alert to the signs of Covid-19.

'Some of the symptoms of Covid-19 do cross over with the indicators of long term lung diseases such as COPD, so this is a good opportunity to encourage people who are now more aware that they are living with respiratory symptoms to find out why they are experiencing them and get an earlier diagnosis.'

Commenting on the taskforce's analysis, NHS Somerset CCG clinical lead Dr Steve Holmes told Pulse that respiratory consultant colleagues have had to change their practice 'hugely' during the pandemic to use their 'clinical skills on the frontline managing those who are seriously unwell', as well as providing advice to GPs.

He said: 'It’s not surprising that respiratory appointments have been reduced dramatically during this time. I’ve been in discussion with specialist colleagues from many parts of the UK and there is a desire to try restore outpatient services, but this is challenging.

'There are issues around infectivity risk and cleaning procedures linked to scanning and imaging, as well as bronchoscopy and spirometry and lung function assessment meaning that many of those being referred for specific tests are having these delayed. This is challenging primary care colleagues to try to highlight those patients at risk of cancer or progressive disease rapidly.'

And Dr Holmes, who is a GP in Shepton Mallet, argued it would prove difficult to return services to pre-pandemic levels at this time.

He said: 'It’s not feasible for most GP practices to do spirometry at the moment, due to the potential risk associated with aerosol-generating procedures. Hospitals have also very dramatically reduced their lung function procedures, often just doing them in very specific situations.’

The news comes as some hospital specilties have warned it will take them two years to clear the backlog of referrals following the pandemic response.

It also comes as lung conditions including COPD have been linked with a higher risk of severe illness of death if they get Covid-19.

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Readers' comments (4)

  • true but also a lot of referrals are pointless and are done for medico-legal reasons. At least these have been avoided. GP spirometry is done badly and interpreted badly and is of little benefit. direct access to HR CT followed by telephone advice would be good enough for many.

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  • Vinci Ho

    (1)You see ,every specialist department are ‘screaming’ with similar warnings , A/E , cancer services etc and now respiratory medicine. What about cardiology , dermatology, rheumatology and more ?
    (2)Primarily , I would argue that this is predominantly a NHSE and secondary care issue . GPs had not closed their services last 3 months as opposed to the perception
    out there.We worked on Bank Holidays . But we were not given the ‘tools’ to operate namely , PPE , intact or contingent referral system to secondary care dogged by rejections , imaging requests being rebuked , restricted phlebotomy services etc .
    (3)The reality of dealing with the consequences of Covid 19 and the lockdown , has only just hit the ground . It is no good to say this is still a period of ‘command and control’ and we could recover but with no additional contingency in order to clear up these backlogs and hence , new referrals .
    Clearly , additional capacity and resources must be there especially considering the fact that every consultation( even phone consultation) requires longer time to cover more complexities due to delayed presentation of symptoms, for instance . And face-to-face is heavily time-constrained for PPE/cleansing issues . As I always say , time is one of the vital resources in medicine.
    (4)These figures created by ‘experts’ ( again !) in their closed-door computer room are telling as a reference , but without tangible , targeted coercion onto the stakeholders in the hierarchy to change their policies .
    Ultimately, we are ‘blaming’ each other at the frontline, widening the gap and dispute between primary and secondary care .
    (5) The government must be held accountable and act differently , urgently now .

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  • Capacity was severely compromised in both primary and secondary care pre-pandemic. Both primary and secondary care staff wanted to continue with the Non-Covid work but were prevented from doing so. We may have saved ICUs from being overwhelmed but it distinctly feels as if if we have won a battle but lost the war. Those who were burning out pre pandemic will now be truly roasted! I suspect a significant number of staff considering retirement will now do so

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  • It will be interesting to study effects on mortality rates due to all this “delayed care”. I suspect we will find that seeing a doctor is often unnecessary or even downright dangerous.

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