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Fund GPs to do spirometry to improve COPD diagnosis rates, report warns

Fund GPs to do spirometry to improve COPD diagnosis rates, report warns

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.’


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Please note, only GPs are permitted to add comments to articles

David jenkins 28 July, 2023 5:55 pm

i have £1000 lying about in my bottom drawer.

question is :

1 – do i give it to my employees etc, as the government told me to (in which case i can continue to provide a service, as i will continue to have staff)

2 – shall i spend it on a sexy new toy, and borrow £500 more so that a jobsworth with 2 o levels can give me a bit of paper proving i can use it ?

if you choose option 2 you will get no thanks, extra work with no extra pay, a bunch of nhs nosey parkers asking you silly questions about when you last had it tested/certified etc, and you’ll generally end up making more work (but, sadly, not more money) for yourself.

…………..a very difficult choice !!

christopher Quinn 28 July, 2023 7:14 pm

One reason for stopping spirometry was the transmission of covid19 by the device . so what about now . what methodology do we use to ensure that there is no spread between patients??.

Peter Lewis 28 July, 2023 7:18 pm

I’m sorry …. Spiromtry is not and never has been a core service
Commission and fund it , and some will do it.
The rest ….. as I said…. It is not and never has been a core service

Peter Lewis 28 July, 2023 7:25 pm

Oh and yes ….. sorry ……
Meant to add …. And make a little profit from the commissioned service , because as in all business services, why would you do anything for nothing

I fully expect lots of negative feedback, but this is the world in which we live

Ian Haczewski 28 July, 2023 8:49 pm

Absolutely spot on Peter, have it fully commissioned

Colin Howat 28 July, 2023 11:57 pm

Perhaps fund it appropriately in secondary care in order that all GP referrals for spirometry are seen within 4 weeks. Initial outlay to ensure the target with diminishing costs ongoing. What is so difficult to understand for the economists? Oh, I forgot, GP’s are ‘best placed’ …… and will do it for less cost!

Colin Howat 29 July, 2023 12:00 am

And I am happy to oversee the service in Primary Care, but what am I allowed to give up?….,,,,’Oh, nothing’ … thought so!

Nicholas Sharvill 30 July, 2023 4:23 pm

I may take issue with this phrase core service. Our staff had training paid for. it increases our ability to do the job well. the increasing divide may just cause bitterness on all sides. There was a time when computer were paid for by partners and telephone services and lots of other things (messaging to patients) now funded centrally but rare to find a GP complaining that the funding of computers and most of their maintenance is now paid for by the state. What are your views on finger print glucose ,ecg and peak flow meter checks… ear syringing… etc etc

Richard Greenway 31 July, 2023 10:47 am

In my view Spirometry, FENO and other new services such as Inclisiran administration need commissioning /funding e.g. through LES- properly worked up with a business plan.

Services like this need:
* Kit -which requires maintenance, calibration, consumables, and has 3-5 yr obsolescence.
* Staff who now need to be trained, accredited, and pay subs to ARTP according to CQC.
* Staff need to be backfilled at cost when not available for normal duties, have on-costs, pension, NI, sickness, holiday met.

I agree GP and staff should be able to do normal procedures, with basic equipment and clinical skills within conventional 10 min appts.

But expectations by hospitals are rising that we are “best-placed” to “take on” e.g. patients with bespoke long term lymphoedema dressing requiring 7 hrs staff time per week- with no funding is unreasonable.