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.
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.’