ICBs should commission spirometry services in primary care and not just rely on community diagnostic centres to provide access, NHS England has said.
Spirometry could be provided by an individual GP surgery, or by groups of GPs, or by a service in a community setting, the new commissioning guidance states.
ICBs and primary care networks should work together to provision locally for spirometry serves their population, by looking at factors such as waiting lists.
And it should be provided in the community through a range of models to reduce unnecessary referrals into secondary care.
GPs and respiratory experts have long warned about patchy provision of testing for lung conditions.
Spirometry services were halted at the start of the Covid-19 pandemic for safety reasons and restarting them has proved challenging in many areas, NHS England said in the set of recommendations.
A report from Asthma+Lung UK in July called on the Government to provide long-term funding for GP practices to offer testing for lung conditions, including spirometry and fractional exhaled nitric oxide (FeNO).
It has been estimated based on a survey of 12,000 people that one in five patients with a chronic lung condition had to wait over a year for an accurate diagnosis.
In May, an Norfolk LMC warned that hospitals were regularly rejecting GP referrals for spirometry.
The latest NHS England guidance for commissioners stressed that even with the additional capacity for quality assured spirometry provided by CDCs, ‘systems still need to commission primary care-based respiratory diagnostic testing’.
Dr Andy Whittamore, a GP and clinical lead at Asthma+Lung UK, welcomed the new commissioning guidelines because there was ongoing concern ‘that spirometry provision is patchy across England with many ICBs still not providing tests at all’.
‘This means that thousands of people are missing out on an accurate and timely diagnosis of COPD every year, which is unacceptable, especially when you consider that lung disease is now the third biggest killer in the UK and a leading cause of winter pressures on the NHS.’
He added the guidance makes it clear that ICBs should commission spirometry to meet demand in their localities which would hopefully clear up some of the misconceptions around CDCs.
‘Previously, CDCs have been viewed as a silver bullet when it comes to spirometry provision, but this misunderstanding has resulted in some ICBs failing to invest properly in locally run spirometry services,’ he said.
‘It is important to stress that CDCs were always intended to boostspirometry provision not to replaceit, because they simply do not have the capacity to meet overall demand.’
A version of this story was first published on our sister title Pulse.
