Exclusive: Quarter of ICBs did not pay GPs to offer spirometry last year

Exclusive GPs in several areas of England are not being paid to offer common tests to diagnose conditions like asthma and chronic obstructive pulmonary disease (COPD), a Pulse investigation has found. 

Experts said that the data shows that many ICBs are still not prioritising spirometry tests in primary care, with some reducing funding or not ringfencing funds for testing. 

The data shows a ‘lottery’ of availability of the LES in England, with 11 of the 42 ICBs (26%) not offering GPs the spirometry LES in 2025/26.

The budget figures, which Pulse obtained from ICBs from Freedom of Information (FOI) requests, also show seven of the ICBs offering the LES to GPs did not increase their spirometry budgets, of which five ICBs reduced their budgets.

The findings are part of a major Pulse investigation on local enhanced services, which is being launched today, including exclusive data and analysis.

A total of 30 ICBs told Pulse they offered a spirometry LES in parts or all of their patches, of which 22 gave Pulse clear budget data. Sussex, Buckinghamshire, Oxfordshire and Berkshire West, Frimley, Shropshire, Telford and Wrekin, and Coventry and Warwickshire all reduced their budgets.  

Meanwhile, Derby and Derbyshire and Bath and North East Somerset, Swindon and Wiltshire ICBs maintained the same budget from 2024/25. 

This variation is also evident in how much GPs are paid to perform this enhanced service, and which costs ICBs factor into their payments. 

Just one in three ICBs providing budget information referenced payments for training or equipment costs associated with providing the LES, according to service specifications seen by Pulse. 

The documents for the spirometry LES obtained by Pulse show that some ICBs put clauses in that would allow them to claw back payments, cap funding per patient, and don’t pay practices if patients don’t attend.  

Dr Paul Evans, a GP and LMC lead in Gateshead, said that underfunding of these services was an issue, and that caps on tests specifically were unhelpful. He told Pulse: ‘There will be some cases where the spirometry tests are done and are inconclusive, or the patient needs a second go, because maybe the first test has been done when they’ve been rather unwell, and it doesn’t draw any definite conclusions about whether someone has asthma or COPD from that test.’

Professor Azeem Majeed, a GP and head of the Department of Primary Care and Public Health at Imperial College London said: ‘The Pulse investigation highlights the persistent postcode lottery in respiratory diagnostic services across England, which will have a direct impact on both general practices and patients.

‘From a practice perspective, the absence or underfunding of a spirometry LES places additional pressure on already stretched primary care teams.

‘Many practices will either have to absorb the cost themselves (which is increasingly difficult given the financial challenges facing general practice), refer more patients to secondary care respiratory clinics (adding to hospital waiting lists) or delay testing. This undermines the ability of GPs to diagnose and manage common respiratory conditions such as COPD in the community.’

Specialist medical accountant Andy Pow, who is an adviser to the Association of Independent Specialist Medical Accountants (AISMA), told Pulse that spirometry was an example of a LES which should be offered universally and where variations in payments to GPs did not make sense. 

Mr Pow told Pulse: ‘For things like spirometry, the price being paid varies massively across the country, but everyone wants the same service, I feel there has to be a national tariff for these things that makes it fair and gives clarity on what people are paying for.  

‘You’d have thought some services are fairly universal in what’s required, and perhaps it just got over complicated because we’ve localised everything.’ 

Asthma + Lung UK’s head of policy and public affairs Jonathan Blades said:  ’Lung conditions are the third biggest killer in the UK and a huge driver of emergency admissions. Spirometry tests are an essential way to diagnose asthma and chronic pulmonary obstructive disease (COPD), and a vital tool to help people access support sooner. 

‘This data shows that too many ICBs are still not prioritising spirometry tests in primary care, with some reducing funding or not ringfencing funds for testing. This is not acceptable.  

‘These stark disparities show why the Government must commit to providing local healthcare services, particularly those in areas of high deprivation, with sufficient funding to ensure everyone can access respiratory tests. 

‘Alongside the respiratory sector, we’re calling for the Government to commit to a Modern Service Framework for respiratory care to improve spirometry access across the country and improve timely and accurate diagnosis.’  

An NHS England spokesperson said: ‘We recognise the importance of early and accurate diagnosis of respiratory disease through quality-assured spirometry.

‘In many areas, spirometry is provided in Community Diagnostic Centres – which are being expanded to more areas of the country as part of a £237m government investment – whereas some ICBs choose to commission this as an enhanced service from GPs.’

Pulse has contacted all ICBs whose data showed had reduced their spirometry LES budgets, or did not offer the LES at all, but only received a response from Shropshire, Telford and Wrekin ICB, who said that the figure provided reflects the ICB spend on spirometry, which ‘can vary from year on year depending on the number of tests carried out’.

Our LES LOTTERY investigation will be published in full later today.