Nationally consistent respiratory diagnostic hubs ‘could save millions’

Neighbourhood respiratory diagnostic hubs should be set up across the country to provide recommended testing for asthma and COPD in primary care, a charity has recommended.

Asthma+Lung UK have called for the hubs to be funded through locally enhanced services on ‘sustainable’ three-year contracts to address poor access for GPs to respiratory tests, to improve patient care and reduce winter pressures.

In a report setting out the need for primary care diagnostics, the charity said the NHS could save millions of pounds by rolling out FeNO and spirometry testing more widely – as recommended by NICE – to speed up diagnosis, cut misdiagnosis and reduce exacerbations.

They said an ‘ad hoc local’ approach to commissioning respiratory diagnostics has led to ‘significant geographical inequalities’ for basic tests that should be standard.

Respiratory diagnostic hubs could provide a ‘one-stop shop’ for patients to get a diagnosis but also referral for other support including stop smoking services and pulmonary rehabilitation, the report said.

Even where services are in place, they can face cuts and recruitment freezes due to uncertainty in long-term funding, it added.

But there are models around the UK that have proven the benefit of having diagnostic hubs for respiratory in place, it said.

This includes the Living Well Partnership in Southampton where GP practices covering over 46,000 patients with above average levels of deprivation have combined GP teams with four respiratory nurse specialists.

Spirometry and FeNO testing is available for both adults and children, commissioned via a locally enhanced service, with both testing and interpretation carried out by the hub.

Respiratory MDT meetings ensure appropriate referrals into community and secondary care, as well as discussing patients who are frequent users of NHS services, including urgent and emergency care.

The Partnership, which is commissioned under a LES contract also employs social prescribers, health and wellbeing coaches, weight loss management coaches and a smoking cessation coach, the report said.

Earlier this year, the charity reported that more than half of ICBs do not have enough spirometry testing capacity to meet demand.

It had also found that one in five patients with a chronic lung condition had to wait over a year for an accurate diagnosis.

The NHS is ‘hurtling towards a respiratory catastrophe this winter’, it has warned with figures showing a 23% rise in the number of emergency admissions over three years for respiratory issues in England since 2022/23.

Dr Andy Whittamore, a GP and clinical lead at Asthma+Lung UK, said: ‘Quick and accurate diagnosis is the foundation of good, equitable respiratory care and a key building block in creating better outcomes for the one in five people living with a lung condition.

‘Without this, lung health will continue to place an unmanageable burden on the NHS, especially during the winter months when emergency admissions spiral.’

He added: ‘If the Government is serious about improving the terrible state of lung health in this country, respiratory tests like FeNO and spirometry must be easily available in primary care.

‘When these are commissioned through GP surgeries, patients can access tests close to home by clinicians who know them, but this can be less practical and more expensive. That is why we want tests delivered at a neighbourhood level and respiratory hubs provide the perfect alternative. 

‘Neighbourhood delivery of respiratory diagnostics, serving a wider population than any single GP practice, can deliver efficient, effective services and bring care closer to patients when they need it. No one should be disadvantaged by a delayed diagnosis and fractured care.’