Diagnosing the problem: Right test, right time

Our new report into the provision of key respiratory diagnostic tests investigates ways to improve early and accurate diagnosis. 

We have focused on the NHS in England and made recommendations for healthcare professionals and commissioners to expand access to crucial diagnostic tests (such as spirometry and Fractional Exhaled Nitric Oxide (FeNO) testing) in primary care for both adults and children. This must be prioritised, despite the difficult financial situation.  

Our report shows

  • Accurate and timely diagnosis of respiratory disease requires primary care pathways that ensure prompt access to diagnostic tests, in particular spirometry and fractional exhaled nitric oxide (FeNO) testing for asthma and chronic obstructive pulmonary disease (COPD), the two most common lung conditions in the UK.  
  • Early and accurate diagnosis of respiratory conditions should be prioritised. This will require funding solutions such as commissioning or other incentives. Our clear and accessible clinical best practice case studies demonstrate how this can be achieved in practice.
  • This report also discusses how the establishment of integrated care systems (ICSs) provides greater scope for local planning to meet the needs of local populations.  
  • This report outlines that community diagnostic centres (CDCs) are intended to add capacity, not replace it from primary care. Action is still needed elsewhere in primary care and services should not rely on CDCs to meet diagnostic demand in their area.

What we are calling for

Our report makes the following key policy recommendations for action at integrated care system (ICS) and national level:  

  • Prioritise respiratory health at ICS level: Integrated Care Boards (ICBs) should develop business cases for respiratory diagnostics. 
  • Workforce planning and training: ICBs should ensure that there is an appropriately qualified workforce in place, by prioritising delivery of training.  
  • Funding spirometry: specific NHS England funding is needed to improve spirometry training at primary care level. Funding should be made available via GP or PCN contracts, or any other suitable mechanisms. ICBs need greater flexibility to allocate funding where it is most needed.  
  • The role of CDCs: NHS England should provide clear guidance that CDCs should not be relied upon as the sole provider of respiratory diagnostic tests.
  • Swift introduction of the new pre-diagnosis breathlessness pathway for adults: we need to see evaluation and wider promotion and roll-out of this pathway within ICSs within the next 12 months. 

At Asthma + Lung UK we will demand early and accurate diagnosis for all people with lung conditions, to ensure that everyone that needs it receives the timely diagnosis and quality care that they deserve.

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