Exclusive Primary care should be properly funded to do spirometry, a leading charity will warn, after figures show plummeting rates of COPD diagnoses.
In a report which will come out next week, Asthma+Lung UK will raise concerns about patchy provision of respiratory diagnostic tests, setting a deadline for NHS England to get better systems in place.
Diagnoses of COPD fell by 51% in 2022 compared with pre-pandemic figures, the charity says.
And the biggest barrier to spirometry testing in many areas is funding, their analysis has shown.
It wants ICSs to restart quality-assured spirometry in primary care ‘in full’ by the end of the 2023/24 financial year.
Community diagnostic centres is one route for testing but should not be relied upon to offer all spirometry, which needs primary care involved for both access and cost-effectiveness reasons, it believes.
‘Spirometry should be incentivised as a paid-for diagnostic test within the GP contract,’ the report a draft of which has been seen by Pulse will conclude.
Asthma+Lung UK also called for clarity from NHS England on funding as well as ensuring ‘funding is used for its intended purpose and additional funding to become available from the central budget to support restart of services and spirometry training at a regional level in 2023–24’.
Pulse recently reported on the gaps in provision around the country – a problem that has worsened since the pandemic when many services stopped for infection control reasons.
A breathlessness pathway that has recently been developed as a collaboration between NHS England and the Primary Care Respiratory Society should also be rolled out within the next year, the report will state.
Current barriers include workforce, training, equipment, funding, certification and physical space, Asthma+Lung UK will say.
Funding can be overcome with the right will, the charity said, giving the example of a locally enhanced service in Gloucestershire which is run as a not for profit paid for service. This type of model should be rolled out wider they added.
Local payment mechanisms should be developed to ensure no one is disadvantaged by setting up a service to meet local needs, the report will outline.
‘Funding should be made available via GP or PCN contracts, or any other suitable mechanisms,’ it says.
The report also noted that ‘NHS England should provide clear guidance that CDCs are intended to boost diagnostic capacity alongside provision in primary care and are unlikely to be able to deliver all respiratory diagnostic testing, even when fully up and running’.
Sarah Woolnough, chief executive of Asthma+Lung UK, said: ‘Even before the pandemic, provision of spirometry was patchy, and it is now even worse as health systems face difficulties re-starting their services.
‘We still don’t have comprehensive data on the coverage of spirometry testing throughout the UK, but we do know it is inadequate. It’s not good enough that people are waiting sometimes years for a diagnosis, and it’s clear that something must be done.
‘One of the biggest issues with restarting spirometry is the funding structure. Spirometry is not included in GP contracts. Instead, integrated care systems have to create a business case for including the test, which is slow and cumbersome.’
She added: ‘We need NHS England to provide more funding for quality-assured spirometry at a primary care level.
We also want to see integrated care boards commissioning and budgeting for all the costs involved, so that spirometry is available in primary care as well as new community diagnostic centres.’