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GPs to directly order tests for respiratory and CVD diagnostics

GPs to directly order tests for respiratory and CVD diagnostics

GPs will be able to directly order diagnostic checks to identify conditions including COPD, asthma, cardiovascular disease and heart failure without a specialist consultation.

The plans, announced by NHS England today, will enable GPs to refer patients with symptoms of heart and respiratory problems for various checks at their local ‘one stop shop’ for scans and tests, based at a hospital or local community diagnostics centre.

Over 90 of these centres are already in operation across England, offering tests including for cancer.

But NHS England said these will be expanded to provide FeNO testing for asthma, blood tests to identify people at high-risk of heart failure and spirometry testing which can help diagnose lung conditions, including COPD.

It claimed ‘up to one million patients’ could benefit from this ‘accelerated access’ and speeding up ‘life-saving’ treatment and medications without the input of a specialist.

NHS England also said that the move ‘has the potential to help NHS staff to continue to reduce Covid backlogs’ and that the additional route for testing could also help ease pressure throughout the winter.

Dr Kieran Sharrock, acting chair of the BMA’s GPC for England, said that while the union acknowledged NHS England’s efforts to tackle winter pressure demands, the notion that it can do so by increasing the GP workload is ‘frankly counteractive’.

He said: ‘These kinds of fast-tracked diagnostic referrals come with the expectation that additional work, such as performing complex investigations not part of a normal GP service, will be done prior to referral and NHSE has provided no details on how already overstretched GPs will undertake the extra work required.

‘Patient referral is a complex process, and many GPs report that their referrals are being returned or blocked by the advice and guidance system with demands for further investigations, treatments, information. 

‘GPs then must re-refer and this not only increases workload but causes further delays for patients. While NHSE suggest they want to enhance GP access to direct diagnosis and shift the workload from hospitals it makes no reference to how it plans to fund the new work that will now be placed on already overwhelmed general practice.’

He also said that wanting to free up consultant’s time is ‘sensible’ but to do so by ‘overburdening another part of the health service is illogical’.

‘It’s time our politicians stop playing whack a mole with our NHS. The entire health service is struggling to cope with demand and the only way to fix the issues at hand is to provide the NHS with adequate funding.’ he said. ‘Only then will patients be able to receive the care that they deserve in good time.’

Dr Rammya Mathew, a GP in London, who had previously warned about the lack of access to spirometry in her borough, welcomed the announcement but said that primary care will likely need to build capacity alongside these plans.

She told Pulse: ‘Having more direct access testing available from primary care is a good thing, particularly when waiting times for secondary care are so long. It will hopefully mean fewer people having unacceptable delays in diagnosis.

‘However, I’ve previously been told that capacity in community diagnostic centres will be limited, particularly for FeNo and spirometry. So it’s likely that primary care will need to build capacity alongside this.’

Dr Selvaseelan Selvarajah, a GP in Tower Hamlets, told Pulse that appropriate support for general practice is needed to back the plans, as practices are struggling with access and workload.   

He said: ‘It’s really important that we have a diagnostic pathway for our asthmatic and COPD patients and it’s something we welcome.

‘However, it needs to come with prompt support from respiratory physicians. What we don’t want, with primary care already struggling with access and workload, is more work to be passed on without the appropriate resources.

‘It needs to be a safe and effective pathway, with appropriate resources for general practice and patients.’

NHS England’s medical director for secondary care and transformation Dr Vin Diwakar said: ‘We know how important it is to diagnose people with conditions like heart failure, COPD and asthma early, so they can get the treatment they need to manage their condition well, and to prevent more serious conditions or illness from developing.

‘Our plans to enhance GP direct access will enable thousands more to get a vital diagnosis sooner, and by capitalising on the additional capacity provided by over a hundred community diagnostic centres offering a ‘one stop shop’ for tests in the community, patients can benefit from convenient triaging and testing near their homes – and importantly, avoid a hospital admission or trip to A&E.’

Sarah MacFadyen, head of policy and external affairs at Asthma + Lung UK, said: ‘We know that too many people with lung conditions, especially those experiencing higher levels of deprivation, are waiting too long to get a diagnosis and the support they need.

‘That’s why these measures to speed up diagnosis and improve access to tests are a welcome step forward.

‘And our latest report also shows that we still need more provision of diagnostic tests like spirometry across the country in primary care, as well as in community diagnostic centres.’

Last week, Pulse reported exclusively on Asthma+Lung UK waring that primary care should be properly funded to do spirometry, after figures show plummeting rates of COPD diagnoses.

It comes after GPs and respiratory specialists warned not enough is being done to provide access to good quality spirometry testing in England.


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

Alice Hodkinson 3 August, 2023 9:16 am

Does anyone see this for what it is? Further defunding of GPs to shift funds to private providers with a pseudo-NHS badge. And of course GPs will have to pick up the pieces, probably via a diagnostic pathway with cut and paste instructions for us to carry out.
We are a profession without a voice. We are not considered to be real doctors who can assess someone and decide with that person what is the best treatment for that individual. Instead we have to provide medicine by numbers, to our detriment and boredom, and certainly not right for the patients.

John Glasspool 3 August, 2023 9:29 am

Strange really: 15 years ago we were doing in-house spirometry, and, as soon as it started, B-NP blood tests for HF.

David Church 3 August, 2023 9:54 am

Will any of these new centres be of real use in easing access? – like, will any of them be more than 40 minutes drive away from an existing hospital?

Turn out The Lights 3 August, 2023 10:46 am

Spirometry now is 9 months to a year locally.About as useful as a chocolate fireguard.

Finola ONeill 3 August, 2023 11:07 am

Exactly right Alice giving funding to private companies to run diagnostics centres that won’t have doctors attached so the investigations and management always come back to us.
Inappropriate when they belong to secondary care management pathways.
Here’s a suggestion we refer to secondary care and they can request and receive the investigations close to home, results going back to the specialist to manage and action.
Up until a couple of years ago we did spirometry in the surgery, the nurses did it.
Then NHSE changed the training needed to be approved and since then no spirometry done.
I diagnose asthma by history and response to treatment. Being able to follow up the patient is essential. Nothing else needed.
And the heart failure blood test, BNP, been available for ages.
Get our nurses trained up properly on spirometry and fund us better.
Happy to continue to diagnose and treat COPD and asthma as we have done for decades, referring up those that are complex or diagnostic uncertainty.
I won’t be managing cardiology patients because I am not a cardiologist.
I suggest we all continue to refer as we always have done and leave this lot to it.

Gary Armstrong 3 August, 2023 11:35 am

If you want industrial action that the majority of GPs could support then non engagement with never ending referral pathways is a good place to start.
I’m happy to refer directly to a consultant for an opinion. This would be a major step to reducing GP bureaucracy!

Andrew Jackson 3 August, 2023 1:54 pm

Our heart failure service is fantastic (although stretched)
We use BNP to stratify severity which guides speed of appointment
They get an ECHO with interpretation in clinic but more importantly have their evidence based medications titrated up by a heart failure nursing team.
A great pathway with GPs doing their jobs and others doing there’s.
If i had to order the ECHO I would have to interpret it and it is almost impossible for primary care to uptitrate medications within current capacity especially if a patient is housebound

Nicholas Sharvill 3 August, 2023 5:38 pm

easy access to good investigations important, ideally for most in house and for others a report WITH SIGNIFICANCE essential ie an echo showing mild mr etc at age 80 is normal. so report to say no action needed, or if mild AS say repeat in 6 months etc (assuming GP writes the reason for echo on the form) Proper interpretation of spirometry by the tester and remember FeNo is 20 % wrong in missing or over diagnosing asthma. Though a huge NHS supporter USS waits have been transformed by ”private’ providers though why the NHS cant match the service when these people make a profit for the same NHS tariff still remains a question nhs providers dont seem able to answer.

Frances Webster 4 August, 2023 7:22 am

I would be pleased to be able to refer direct to test but agree with other comments that I don’t have knowledge/capacity to interpret the results. That is where my patients deserve a specialist opinion.
A system where results requiring action beyond prescription change or longer term monitoring were reviewed and prioritised by a consultant who would take ongoing responsibility is surely not too much to ask and would be both a rational use of GP and specialist time and a more streamlined process for the patients.