Most plans for acute respiratory hubs not yet in place despite growing GP pressures

Exclusive A Pulse investigation has highlighted variation across England in the use of acute respiratory infection hubs to relieve pressure on GPs, with only a handful up and running.

In a letter to ICBs about winter resilience plans in October, NHS England said there should be ‘active consideration’ of acute respiratory infection hubs to support same day assessment in what was likely to be a ‘very challenging winter’.

But responses to Pulse from ICBs about their plans showed that while the majority are considering whether to put an acute respiratory infection hub in place, many have yet to come to a conclusion.

Only four areas who responded already have a hub up and running, including South Yorkshire and Staffordshire and Stoke on Trent, Surrey Heartlands and South East London which said it had ‘multidisciplinary pathways’ in place to manage respiratory infections.

A further six of the 26 ICBs who responded will be putting respiratory hubs in place but they are not operational yet, Pulse understands.

The vast majority of respondents said they were still doing scoping exercises to determine how best to set up services for acute respiratory illness.

Of three who said they had no plans to put hubs in place, some said they had opted for a virtual ward model instead.

A document to support local systems to design the hubs said they would provide additional capacity to support both primary care and hospitals.

The hubs can support same day assessment and specialist advice, access to diagnostics and reduce the burden on GPs, 111, A&E and hospital admissions.

Such an approach would also separating the high expected flow of infectious patients through hubs rather than usual GP waiting rooms and clinics.

The NHS is already seeing pressures in both primary and secondary care due to high levels of respiratory viruses including Covid and in particular flu.

In the latest figures from the week up to the 15 December showed rising consultations and hospitalisations for influenza as well as rising hospital admissions for Covid-19.

Influenza positivity increased to 20.2% in the past week with highest positivity seen in the 5 to 14 years age group at 32.9%, data from the UK Health Security Agency showed.

Dr Laura Mount, a GP in Warrington and PCN clinical director, said an acute respiratory infection hub had not been set up in her area yet. Cheshire and Merseyside was one of the regions that did not respond to the Pulse request for information.

She said: ‘We have been asking for months about plans for such a surge and been told that there would be no extra resource. 

‘Last week we were told that there is now some limited resource but the hubs must be set up to cover 250,000 people therefore covering multiple PCN populations which actually makes set up quite difficult.’

It has left questions about who will host or manage it across multiple PCN areas, she said. 

‘Also, our neighbouring ICS in Manchester started these three weeks ago so potential locum staff will already be contracted with them. We are actively working with the ICS as a PCN to support the set up at pace.’

Dr Bruce Hughes, a member of the medical executive team at Devon LMC said: ‘The current situation as far as I know in Devon is that there was talk about setting up a hub but nothing is in place yet.

‘The major issue is of course that there is nobody to staff them without denuding an already broken system in general practice.’

Finding the staff to work in the hubs is a major barrier other GPs have also told Pulse.

Dr Helen Salisbury, GP in Oxford and member of Keep Our NHS Public said she had not seen any plans for hubs in her area. ‘There is some funding for extra GP/nurse hours between now and Jan 6th but as always it’s hard to find staff to do extra work,’ she added.

Dr Grant Ingrams, chair of Leicester, Leicestershire and Rutland LMC said there was one paediatric respiratory hub for the region going live this week and plans for further hubs for adults and children were in progress.

‘I hope will be helpful, but depends on where they are situated, the capacity and whether we can directly book into them,’ he said.

Figures from the Office for National Statistics show that rates of Covid are rising once more with one in 50 people testing positive. It is the third week in a row of rising rates.

Other respiratory illnesses including flu are also putting pressure on services, figures show.

The number of patients with flu in hospital rose two-thirds in the past week and 50% in critical care beds.