More patients in Gloucestershire are receiving faster and more reliable diagnoses of asthma thanks to an ambitious project designed to ensure adoption and spread of proven innovative products, according to a new evaluation. Three Primary Care Networks in the Stroud and Berkeley Vale locality of Gloucestershire took part in a project, led by the West of England AHSN and delivered by Gloucestershire Integrated Care Board (ICB), which supported practitioners from 17 practices to deliver FeNO testing following face to face training and e-learning modules. The project resulted in 272 patients receiving a diagnosis of asthma.
FeNO testing is part of the Rapid Uptake Products (RUP) programme to increase uptake of NICE approved products. FeNO devices measure fractional exhaled oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs. This can be used to aid in the diagnosis of asthma. It is a quick and easy test that can be carried out by any healthcare professional that has received training. Benefits of FeNO testing include:
- improved speed and accuracy of diagnosis for patients suspected of having asthma
- improved patient care and outcomes, reducing the risk of exacerbations and hospital admissions
- reduction in inappropriate prescribing and referrals to secondary care
Prior to this project, FeNO testing was only offered at a hospital-based clinic that ran sporadically over a 5-year period and therefore wasn’t widely available across the county. This clinic was re-established for 7 months at the start of the project to provide a blueprint for primary care based FeNO testing. The project evaluation has found during these seven months, 18 practitioners attended the clinic for training from a Senior Nurse Practitioner and to receive a FeNO device for their practice. This enabled the transfer of respiratory clinics from the hospital setting into primary care, with 431 patients accessing a FeNO test in their GP practice between October 2021 and June 2022 and 272 patients receiving a diagnosis of asthma. The evaluation also noted provision of FeNO testing at a local level has improved access and reduced travel for patients, with over 75% of patients surveyed travelling less than 6 miles and waiting less than 2 weeks for an appointment.
FeNO testing has since been rolled out at practice level across Gloucestershire to ensure equity of access as part of a system wide Respiratory Diagnostics Local Enhanced Service (LES).
The West of England AHSN supported the application for Pathway Transformation Funding to enable the purchase of FeNO devices, in addition to the use of the hospital-based clinic as a route to delivering training to practice staff. Project management support was provided by the AHSN to monitor the project timeline, collect and analyse data and record risks and issues. Surveys were co-created and regularly reviewed to measure and continuously improve staff and patient experience of the new service. As part of the AHSN’s regional FeNO Programme, it co-ordinated the delivery of education webinars that were open to healthcare professionals across the West of England – these were attended by 90 delegates.
“Having previously offered FeNO testing following referral and seen the improvements in accurate diagnosis, patient education and confidence in self-management, we are now able to offer the test without the delays associated with referral, close to the patient in their GP practice with competent health care professionals in a way that is sustainable in the longer term. We achieved the aims of our project and have also been able to roll out the model across the whole ICB”.
Carol Stonham, Senior Nurse Practitioner – Respiratory, Gloucestershire ICB
“It has been great to work with the ICB on this project, who have really championed the use of FeNO testing in primary care. The data from this evaluation demonstrates how patients are benefitting from easier access to FeNO testing, which will continue thanks to system wide support”.
Charlotte Hallett, Senior Project Manager, West of England AHSN