If FeNO testing was made available to all GPs across England, it could save almost £100m by making best use of treatment, analysis by a leading lung charity has found.
The lack of simple tests for GPs to diagnose lung conditions is forcing them to play a ‘guessing game’ and costing the NHS billions, Asthma+Lung UK warned.
In a report outlining the ‘dire state’ of lung healthcare in England, the charity said an ongoing lack of spirometry and FeNO testing – despite clear recommendations from NICE – was costing £2.2bn in avoidable hospital stays and treatment.
An analysis from PwC commissioned by Asthma+Lung UK found that if 40% of eligible patients had spirometry done to diagnose COPD, it would save £60m in treating fewer exacerbations and cut more than 63,000 hospital bed days.
The charity has called for both spirometry and FeNO to be fully funded across all settings in primary care, including as a paid-for diagnostic test within the GP contract.
And while there have been proposals to include respiratory testing within community diagnostic centres (CDCs), this should be done to ‘boost capacity’ alongside provision in primary care, it said.
All integrated care systems (ICSs) should be asked to provide evidence that all patients from every PCN have access to timely, high-quality spirometry and FeNO testing by the end of 2023/24, it added.
In addition to people not being diagnosed due to lack of testing, patients can also be wrongly diagnosed with the report warning that as 750,000 people in England are misdiagnosed with asthma, costing an estimated £132 million every year.
There is also a huge opportunity to reduce hospital demand by ensuring patients with asthma and COPD receive best practice after their diagnosis, it said.
This would include annual review and inhaler technique checks for asthma patients and pulmonary rehabilitation for those with COPD, which is currently ‘extremely limited’.
Increasing referral and completion rates for pulmonary rehabilitation to 80% and 50% would save the NHS £142.6 million in direct savings from reduced exacerbations, the PwC economic analysis found.
Overall lung conditions cost the NHS over £9.6 billion every year and are a leading cause of winter pressures on the NHS, the report warned.
Properly implementing simple steps to improve diagnosis and care for asthma and COPD would save the NHS far more than the £250 million earmarked for 5,000 extra beds to deal with winter pressures in the coming months, it added.
Speaking with Pulse, Dr Andy Whittamore, a GP and clinical lead at Asthma+Lung UK said NHS contracting had not kept up with NICE guidance.
‘The pandemic shone a light on this when spirometry stopped in primary care then started back up again, there lots of things not in place, including that GPs were not funded to do it, as well as the lack of respiratory workforce, the need for training and accreditation and the upkeep of the kit.’
He added that he was not sure CDCs had the capacity to do all the testing that was needed in primary care and diagnostics need to be easily accessible.
‘There is a big piece of work that ICSs need to do to look at the needs of their population, the respiratory workforce and to put plans in place so that it is very clear for practices and PCNs who is responsible for providing this.’
Sarah Woolnough, CEO of Asthma+Lung UK, said lung conditions were the third biggest killer in the UK: ‘The abysmal lack of testing and patchy basic care is causing avoidable harm to people with lung conditions and the NHS.
‘There are huge savings to be made by improving the diagnosis and treatment of lung conditions such as asthma and COPD, in terms of direct NHS savings, including reducing hospital bed days.
‘It doesn’t make sense that lung conditions aren’t given the same priority as other big killers such as heart disease.’
Never heard of it
Quite loud broadsides being critical of GP asthma /copd care based on PWC report.
Gold standard testing seems long way off with all the other demands and funding cuts and perks an old fashioned view but could we have bronze standard spirometry for most and only gold for those where spirometry not obvious or no h/o smoking and relevant ‘recurrent chest infections’
There are so many smokers that seem to be unaware they have already or are heading towards copd and bronze quality quick spirometry may be all that is needed to nudge them into stopping smoking which is so much more valuable than long term inhalers..
FeNO and asthma. The report des not mention in the headline that this can also over and under report asthma so not foolproof but why have those that organise and commission care not rolled this out years ago but someone has to pay for it (ie NHS) and nobody seems to want to!
Haven’t read thee report but the headline troubles me. What is the probability of saving £100million , I think I need to know this inorder to work out the real savings.
However if you want to make savings for the nhs how about creating a website inviting suggestions. If you’re suggestion is realised after analysis then you get a percentage of the savings
GPs are not inherently more expensive / hour than hospital consultants, and are definitely more expensive than specialist nurses of physician associates.
If money could be saved by doing this in primary care why not just do it for cheaper in secondary care ‘at scale’?
Or is GP time costed at £0?
Just this week I had a referred for paediatric ? asthma rejected by our local centre of optimism due to ‘not commissioned to diagnose asthma’.
Unfortunately like many of such rejections they are often based on whispers, myths and wishful thinking, but it causes further delay to the ‘patient journey’ and wastes more (‘free’) GP time.
‘An analysis from PwC commissioned by Asthma+Lung UK found that if 40% of eligible patients had spirometry done to diagnose COPD, it would save £60m in treating fewer exacerbations and cut more than 63,000 hospital bed days.
The charity has called for both spirometry and FeNO to be fully funded across all settings in primary care’
1. GP nurses all did their own spirometry until training criteria were changed and nothing was organised to retrain our staff.
The quickest solution is to look at those changes in training standards and rv if they are truly necessary. Nothing was broek so why the ‘fix’.
2. there is no evidence given on FeNO. Considering we have managed to diagnose asthma and treat it without this test for decades; both within primary care and all the respiratory jobs I’ve done, and I can never recall a respiratory OP letter quoting this test, how is it now being found necessary?
Who is hoping to make all the money from this?
Community diagnostics centres run by private companies?
Why did they change primary care spirometry training criteria without consulting us or considering the consequences?
NHS management is a shit show.
Reconsider the criteria for spirometry training and change it back.
Our nurses have been doing it for years.
There is no problem apart from one created by this fiasco.
FeNO is not of great use in diagnosis, but has the ability to assist in assessing whether the asthma might be steroid responsive. The savings would come from reducing doses of inhaled steroids in those who are not benefiting from them. Current guidelines recommend increasing the dose of inhaled steroids if control is not established. FeNO may be elevated because 1. the patient is not taking them, 2. their inhaler technique is faulty, 3 their disease is not steroid responsive 4. They do not have asthma.
Used properly it is a very helpful tool and by reducing the amount of steroid used has the potential to reduce iatrogenic diabetes obesity, reflux, osteoporosis cataracts, etc etc
….but of course it needs to be funded, and we all know that if it works and is effective, NHSEnland will not recommend that.