More than half of integrated care systems (ICSs) do not have enough spirometry testing capacity to meet demand, new research by a lung health charity has found.
In a survey conducted by Asthma+Lung UK, 16 out of the 27 integrated systems who are commissioning spirometry across the whole system said they did not have sufficient testing capacity.
Meanwhile, only eight of the 27 systems reported having enough capacity to meet demand for both new referrals and for any backlog, according to the results.
The charity is calling for a £40m spirometry fund to ensure ‘equitable access to testing across England’ so that patients with symptoms of a lung condition can receive a ‘quick, accurate diagnosis’.
‘We want the government to prioritise the diagnosis of respiratory patients by providing a spirometry recovery fund of £40 million over the next two years, with more funding to those ICSs experiencing higher levels of deprivation,’ the charity said.
In the meantime, Asthma+Lung UK called on ICSs to ‘prioritise the delivery of spirometry training’ to GPs and to ‘establish a local funding mechanism so that spirometry can be delivered in primary care across England’.
The survey, which was conducted in October, received responses from 32 ICSs, of which 27 are commissioning adult spirometry in primary care, with the majority (15) doing so via a locally enhanced service (LES).
Asthma+Lung UK said 1.7 million people in the UK live with chronic obstructive pulmonary disease (COPD) with around 600,000 more living undiagnosed.
The charity warned that the current gap in spirometry provision means ‘hundreds of thousands of people’ with COPD symptoms ‘may wait years for a diagnosis, or not get a diagnosis at all’.
Sister title Pulse has previously reported on the gaps in provision around the country – a problem that has worsened since the pandemic when many services stopped for infection control reasons.
Chief executive Sarah Sleet said lung conditions are the ‘top cause of emergency hospital admissions’ and it is a ‘scandal that they’re still not being prioritised’.
She added: ‘Now we need the government to recognise the importance of good respiratory care. They must provide local healthcare services with sufficient funding to ensure everyone gets the test they need, with a focus on providing more resources in areas with the highest levels of deprivation.’
In 2023, the charity had said that primary care should be properly funded to do spirometry, after figures showed plummeting rates of COPD diagnoses.
The new data is part of Asthma+Lung UK’s first ‘respiratory review’ which sought to give a gauge of the current state of respiratory care.
Professor Azeem Majeed, a GP and head of primary care and public health at Imperial College London, said that it was ‘concerning’ that the majority of ICSs lack sufficient spirometry capacity, as this directly affects the ability of NHS staff to diagnose and manage asthma and COPD effectively.
He told Pulse: ‘Spirometry is a vital tool for diagnosing respiratory diseases, and its underuse or limited availability can lead to delayed diagnoses, poorer outcomes for patients, and increased pressure on the NHS.
‘The call from Asthma+Lung UK to prioritise spirometry training for GPs and establish local funding mechanisms is therefore both timely and necessary.’
He added that training GPs and primary care teams is ‘a practical step forward’, as it empowers frontline staff to conduct these tests ‘accurately and efficiently’.
He added: ‘However, even with well-trained staff, the lack of adequate funding will hinder the implementation of these necessary changes. Establishing a local funding mechanism is crucial.
‘Currently, the patchwork of funding — often reliant on slow and cumbersome business cases within ICSs — can hinder timely service delivery.
‘A more streamlined approach, where primary care is consistently supported to provide quality-assured spirometry, would help address inequalities in access, especially in deprived areas where respiratory conditions are more common.’
Doctors’ Association UK (DAUK) GP spokesperson Dr Steve Taylor said the lack of spirometry is ‘concerning’ and that ‘cuts in funding have been short-sighted’.
‘The lack of joined up approach nationally is causing confusion for patients and creating areas where patients are not able to access important diagnostic services,’ he told Pulse.
In October, NHS England instructed ICBs to commission spirometry services in primary care and not just rely on community diagnostic centres to provide access.
The new commissioning guidance stated that spirometry should be provided by an individual GP surgery, or by groups of GPs.
NICE’s new joint asthma guidelines, finalised in November, recognised the patchy access to spirometry testing, and advised alternative peak expiratory flow (PEF) testing where spirometry is not available.
A version of this article was originally published by our sister title Pulse
