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GPs to send children with asthma to diagnostic hubs under NHSE plans


children asthma


GPs will have access to diagnostic hubs for asthma in children and young people, under new national care standards from NHS England.

New guidance said that ICSs should develop a diagnostic hub run by health professionals trained in diagnosing asthma in young patients and with access to spirometry and FeNO.

They should also develop ‘clear criteria’ for referral to secondary care from the hubs, it added.

But GP leaders warned that this could duplicate work already done in practices and lead to the removal of asthma diagnosis points from QOF.

The guidance, published last month, also said that every primary care network (PCN) must have a named asthma lead and all ‘at-risk’ children and young people should be discussed at a PCN multidisciplinary meeting that includes a GP and paediatrician.

At-risk patients would include those who have had two asthma attacks in the past year or are presenting ‘frequently’ to primary care or emergency departments or having frequent hospital admissions, it said.

They should also be assigned a key worker and have a home visit, according to the guidance.

An accompanying resource pack suggested that the visits should be ‘nurse led’ but it remains unclear whether GPs would also be expected to carry them out.

Dr Dean Eggitt, a GP and chief executive officer of Doncaster LMC, said his area had been working on setting up respiratory diagnostic hubs over the last year but these were of most use for diagnosing COPD.

‘The diagnosis via a hub seems unnecessary. It’s easily done via peak flow readings and FeNo is required in only niche cases in reality.’

He added that the diagnosis of asthma via demonstration of reversibility is currently part of QOF.

‘There is little chance that NHSE will pay for the service twice, so we should expect this to be removed from QOF, or amended,’ he said.

Professor Azeem Majeed, GP and professor of primary care at Imperial College London also said it was important that the hubs did not duplicate work already been done in GP practices and hospital outpatients.

However, he added: ‘Easy access to spirometry and FeNO testing would be useful as a lot of practices are not able to offer these services’.

And he said that multidisciplinary meetings at the PCN level cannot just be a talking shop.

Professor Majeed told Pulse: ‘One question that GPs will ask is that this kind of MDT activity, although useful for patients, takes up a lot of time and it’s important that if it is done, GP time is covered so that access to GP services does not suffer.

‘In principle, I think it is helpful to review children who have frequent asthma attacks or require hospital treatment to see if their care can be optimised. However, home visits are not generally a productive use of time and it might be better to offer these children an appointment in a clinic or a telephone appointment in the first instance.’

The document outlines the first phase of NHS England plans to better integrate asthma care, with final guidance set to be published in Spring 2022.

The new national standards follow a 2015 review of asthma deaths by the Royal College of Physicians which identified several avoidable factors both in patient care and in relation to patients, families and environments.

‘Despite pockets of good practice emerging since this report, widespread improvements in [children and young people] asthma care are yet to be realised’, the NHS England guidance said.

Research shows asthma is ‘often perceived as a mild disease’ and ‘not taken seriously enough’, it added.

NHS England also noted that inconsistency between BTS and NICE guidelines is causing confusion, particularly in primary care.

‘There is a need for one single set of guidance for the UK, which is regularly updated, comprehensive and evidence-based covering both diagnosis and management,’ it said.

BTS and NICE are working on UK-wide joint guidance on asthma diagnosis and monitoring and management that will update and replace the 2017 NICE guideline.

Around one in 11 children and young people live with asthma in the UK, which also tops the tables for childhood asthma emergency admission and death rates in Europe.

It comes as children aged 12-15 with poorly controlled asthma were last month added to the list of those vulnerable to serious illness from Covid and fast-tracked for a Covid vaccine.

READERS' COMMENTS [3]

IDGAF . 11 October, 2021 4:23 pm

Dear Colleague,

Thanks for seeing this young child with asthma. I have done the necessary examination and investigations and my impression is that this is asthma. I am a little hesitant about starting treatment for asthma because it is possible that this is not asthma. I have discussed this with my advanced nurse practitioner who also suspects it might be asthma but as we are both incompetent, lazy and avoidant of face-to-face contact (this present case excepting, as I could not understand the childs speech through all the wheezing) I would value your assessment.

Kind regards, Dr DGAF.

Patrufini Duffy 11 October, 2021 5:50 pm

Yes IDGAF.
Waiting for the “specialist” assessment whilst they can’t breath. And for a GPsi more junior than you to diagnose it. In the old days it was called a referral to paediatrics or a respiratory nurse. Now it’s a Hub. Blub, Bob, Blurb, Bleep.

Modern reply:

I’m sorry, but your referral is rejected.
Please ticket the “given the patient a leaflet box” before referring the patient, and fill in the pet and excercise questionnaire on the proforma and safeguarding sections. Please also complete the PHQ-9 to ensure this isn’t just anxiety.
Best wishes.

Someone in the Trust.

Jonathan Heatley 12 October, 2021 12:18 pm

doing a referral to secondary care is becoming more and more time consuming as the templates that they demand are getting so detailed you feel you are doing their work for them. This plus the fact that each hospital has its own templates and we often use three different DGHs means its a chore to find the right forms then it takes ages to fill them in. Oh for that long gone golden era where the letter went ‘please see and treat’.