FeNO testing improving asthma diagnosis in region

The West of England AHSN has been supporting several projects to implement FeNO testing in primary care over the past six months.  There are now 16 GP practices across the region that have access to FeNO devices, with a further 60 practices planning to go live in the next two months.  The South West Respiratory Clinical Network has provided funding for a further 7 devices across the West of England region which improves access for patients.

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

Following successful bids for Pathway Transformation Funding, Bath and North East Somerset, Swindon and Wiltshire CCG (BSW CCG) and Gloucestershire CCG were awarded funding to implement FeNO testing and are currently piloting the approach using a number of different models.

In BSW, FeNO testing is being made available to all GP practices in the region and is being supported by locality clinical leads in each area.  Many of these practices are currently using a mobile model and sharing FeNO devices to ensure equity of access for their patients, with some areas trialling a fixed hub model, with a view to comparing the two approaches in a project evaluation.

Nicci Mawer, Nurse at Combe Down Surgery said:

“We have been using the FeNO machine in my practice for a couple of months now.  I started using it with a degree of scepticism but can honestly say it is a valuable tool for aiding the diagnosis of asthma as well as monitoring existing patients who are uncontrolled and needing potential treatment change or can be informed that their current treatment is working.  It is easy to use and clean and can be done in a 10 minute appointment if you are only performing FeNO.  Patients find holding and breathing into the device quick and easy and it proves to patients that there is inflammation that needs dealing with.”

Gloucestershire received funding to introduce FeNO testing in 19 practices across one locality and are implementing this with a hub and spoke model, with staff attending training at a hospital clinic with a Senior Nurse Practitioner before receiving a device to use in their own practice. This has resulted in the CCG funding a wider rollout of FeNO testing across their whole region, with another 41 devices about to be deployed.

Funding and project support available

Whilst providing project management support to the existing FeNO roll out, the West of England AHSN is also able to extend this offer to individual Primary Care Networks looking to implement FeNO testing. The AHSN can co-ordinate training and signposting to educational resources, facilitate clinical pathway design and liaise with analysts around data collection. To promote the benefits of FeNO testing more widely, webinars have been delivered throughout December and January with 63 attendees from across the West of England.

The South West Clinical Network is really pleased to support this initiative as outlined by Adrienne Rogers, Clinical Network Manager:

“We’re delighted to support the extension of FeNO use across the South West Region by the provision of additional FeNO devices to map onto gaps identified from our Primary Care Respiratory Champion programme, plus thousands of mouthpieces to enable greater delivery for the region’s AHSN -supported FeNO projects in primary care.”

FeNO offers an opportunity to support both the early and accurate diagnosis of asthma, as well as monitoring compliance and effectiveness of asthma management. This will all help our regional systems to deliver on their commitment to the NHS Long Term Plan, and support our respiratory populations to access the right care at the right time.”

You can find out more about FeNO testing here.

If you’re interested in implementing FeNO  in your practice and would like to find out more about accessing funding and support please contact Senior Project Manager, Charlotte Hallett.

Find out more about the West of England’s work to identify gaps and priorities and signpost proven treatments and diagnostics through programmes such as Rapid Uptake Products and Med Tech Funding Mandate.




Sharing the learning at evidence and evaluation ‘Train the Trainer’ day

On 27 September 2017, the West of England AHSN and NIHR CLAHRC West ran a ‘Train the Trainer’ day to share resources and experience of running the workshops – ‘Finding the Evidence’ and ‘Getting Started with Service Evaluation’.

142 NHS commissioning staff across the West of England have attended these workshops since March 2016, reporting changes in evidence use and evaluation activity as a direct result.

Interest and demand from outside the West of England led to the development of this ‘Train the Trainer’ day, where 12 places were offered nationally via the CLAHRC and AHSN networks. The day was attended by staff from two CLAHRCs, four AHSNs and one Clinical Commissioning Group, all of whom are considering creating their own evidence and evaluation training programme.

The training team shared a host of prototype resources which consisted of a slide deck for each of the workshops, as well as instructive tutorial videos to be used as part of a face-to-face workshop, as preparatory material, or as stand-alone learning aids. The videos included:

  • Show me the evidence: the why and how of finding and using evidence
  • An online tour of the Evidence and Evaluation Toolkits
  • How do I get started with searching for evidence?
  • What is evaluation and why is it important?
  • How to plan my evaluation using the 5-step evaluation cycle
  • Different approaches to collecting data in an evaluation

Feedback was very positive, with delegates commenting that the online resources were “informative, creative and engaging…I will definitely use in delivering training myself” and that the day itself was “completely relevant and very useful”.

As a result of this successful event, the training team will complete the suite of on-line ‘Train the Trainer’ resources for national launch in January 2017 to strengthen the culture for evidence-informed practice across the health community.

For further information, contact Jo Bangoura j.bangoura@nhs.net

New evidence-informed case studies

How do I get started with an evaluation?
Where do I look for evidence?
What difference will it make anyway?

If you are new to service evaluation or don’t have experience of searching for evidence you may be wondering the answers to these questions. Don’t scratch around – learn from what other people have done!

Together with NIHR CLAHRC West, we have collected case studies from a variety of sources to demonstrate how evidence reviews and evaluations can lead to improved patient safety, cost savings, enhanced efficiency and policy changes.

For example, you could learn how Bristol Clinical Commissioning Group (CCG) has made a potential saving of £100,000 per year across Bristol, North Somerset and South Gloucestershire. Or how Swindon CCG has influenced antibiotic prescribing behaviour within the out-of-hours GP setting.

Check out the full list of case studies here.

More tips and resources on how to complete your own service evaluation or evidence review can be found on the NHS Evaluation Works and Evidence Works toolkits.

Recent highlights of our work together

The West of England AHSN continues to be recognised for successfully bringing together healthcare, industry and academic partners across the region – but what are we are actually achieving together? Here are a few highlights from the last quarter, October to December 2015…

Patient safety

  • 10,000 people have benefitted from the emergency department safety checklist so far this last year, which has been piloted by University Hospitals Bristol NHS Foundation Trust. We are now supporting four other EDs to implement the checklist: Weston Area Health NHS Trust, North Bristol NHS Trust, Gloucestershire Hospitals NHS Foundation Trust, and Great Western Hospitals NHS Foundation Trust.
  • The two Bristol Trusts have successfully converted from the Bristol Early Warning Score to the National Early Warning Score (NEWS).
  • A great example of collaborative working: 80 delegates from across the South of England attended our Mental Health Collaborative learning event in December.
  • The Emergency Laparotomy Collaborative is live including all six acute trusts. This work will benefit 1,000 patients a year in the West of England.
  • To date, 435 staff from community organisations have already received Human Factors training. We are now providing funding to Bath & North East Somerset CCG, Bristol Community Health, Gloucestershire Care Services and North Somerset Community Partnership to enable a further 2,500 staff in community settings to receive training.


  • Connecting Care has been used to review patient records on 110,000 occasions. Gloucestershire CCG has a final business case which will deliver interoperability in 2016/17. Wiltshire and BaNES are enhancing local systems to connect data for patient benefit across care settings.
  • Patients in the West of England are set to benefit from a new NHS Genomic Medicine Centre based in Bristol, which gained approval in December.

Quality improvement

  • 80 GP practices in Gloucestershire are working with us on our Atrial Fibrillation programme. The first 11 practices found 533 high risk patients who may need clinical review.
  • We have trained 46 GPs, 15 nurse practitioners and health care assistants, and 12 pharmacists as part of Don’t Wait to Anticoagulate, with a further pharmacist training session planned.


  • The OpenPrescribing platform been used on 25,000 occasions, with 94,000 page views, and shares on Twitter have reached a potential audience of 46 million people. The concept has now spread to Wales and Scotland.

Join Dementia Research

  • At Christmas the West of England had achieved number one slot for the highest number of local registrations to the Join Dementia Research service in the country.

Diabetes Digital Coach

  • The Diabetes Digital Coach programme, developed by a consortium led by the West of England AHSN, has been selected as an ‘internet of things’ Test Bed to help people with diabetes in the region self-manage their condition.

Supporting innovation

  • We have supported Folium Optics who have been awarded £1 million funding from SBRI Healthcare competition to further developed their ‘smart tag’ which reminds people to take their medication.

Everything we do and achieve is in collaboration with an extensive range of individuals and organisations across the West of England and beyond. Thank you to all our members, partners, public contributors and staff!

Measuring demand in general practice – new report published

A new study has been published exploring how demand is measured and managed by GP practices in the West of England.

The West of England AHSN commissioned the study, in partnership with NIHR CLAHRC West, as part of its Commissioning Evidence Informed Care programme, which is led by Dr Peter Brindle.

Demand for Primary Care services exceeds capacity available. With increasing cost pressures, increase in patient expectation and advances in medicine, more people are visiting their GP than ever before. With no new monies available to significantly increase GP numbers, the West of England AHSN is advocating an evidence-based approach to measuring and managing demand.

There were three main aims to this research:

  1. To review existing literature and to scan regional and national projects that aim to measure
    and manage demand.
  2. To understand how GP practices currently measure and manage demand and how they use
    routinely collected data to predict demand and strengthen capacity planning.
  3. To gain an overview of the three Prime Minister Challenge Fund sites in the region and to determine their approach to measuring and managing demand.

The study highlights a lack of research in this area and a lack of continuity in national projects aimed
at supporting GP practices to understand demand. It therefore provided strong evidence supporting the need for a study of this kind and for further investigation of this area.

Work with GP practices revealed no definitive or widespread approach to measuring demand in primary care. However it confirmed that practices and clinical commissioning groups (CCGs) were struggling to cope with apparently increasing demand and were very keen to engage in further activities that might help understand and manage it better.

Download a copy of the full report here for a full analysis of the findings and recommendations for next steps.

Support for OpenPrescribing from GPs, commissioners and the world!

In December the new online prescribing platform, co-developed by Anna Powell-Smith and Ben Goldacre with support and funding from the West of England AHSN, was launched publicly to an overwhelming positive response.

OpenPrescribing.net enables the speedy analysis of prescriptions across the country for the first time and has the potential to save the NHS millions of pounds, while ensuring that patients are given the best medication for their conditions.

The new platform generated significant interest, receiving nearly 95,000 hits during December. Twitter was flooded with conversations about OpenPrescribing, with this one being the most shared. In all there have been 431 tweets and 1,691 reactions, reaching a potential audience of around 46 million people.

Since the launch, an equivalent site for Welsh prescribing data using open source code from OpenPrescribing.net has been developed, while the Scottish government has also confirmed it will release their data which means an equivalent Scottish site could be available later this year.

A GP’s perspective

According to GP Peter Jenkins, every month prescriptions are issued for 450,000 individual drugs across the Wiltshire region, where he is based, equating to five million a year. This huge volume results in a very large amount of data being recorded and made available, but it is not always easy to interpret, making it a challenge to distinguish patterns in prescribing.

Peter Jenkins, Bristol CCG
GP Peter Jenkins

Dr Jenkins, who is also Clinical Chair at NHS Wiltshire Clinical Commissioning Group, says: “Data intelligence provides a method to review our own prescribing and benchmark it against our colleagues locally and nationally. It is obviously only related to prescribing and needs to be taken in context with other aspects of patient care, but it provides a tool to enable further review and improvements where appropriate.

“I am aware that GPs have previously used information that was available from the NHS Business Services Authority (PPD) in the form of a quarterly prescribing report for each practice. This became unavailable a couple of years ago and the only way we’ve been able to access this kind of information up to now is to request it from our medicines management team.”

He added: “The OpenPrescribing platform will allow GPs to use prescription information to review practice prescribing performance and compare it to other practices locally, or even nationally. We will be able to identify areas for potential audit, and perhaps improvements in practice, if it is not according to local or national guidance.

“The platform makes data easily accessible on mobile devices, such as an iPad, as well as on a computer, and can be accessed from anywhere, not just an NHS computer. It is very user friendly and you can manipulate the graphs to expand the details you want to see. Being able to view graphs is always more meaningful than tables of data and the option to review the progress over a period of time is very helpful.”

A commissioner’s perspective

Jon Hayhurst is Head of Medicines Management at Bristol CCG, which has ongoing programmes of work that involve collaboration between GPs, with the aim of making prescribing safer, more effective and more sustainable. Jon says: “A number of IT interfaces currently allow people like me to access the rich prescribing data that we get from our GPs – ePACT.net or the Information Services Portal to name two. These are great for those of us that regularly view such data, but can be impenetrable for those that don’t.

GP Jon Hayhurst
Jon Hayhurst, Bristol CCG

“We will be encouraging our local clinicians and other partners to use the OpenPrescribing platform to see variation in prescribing for themselves and encourage them to have a play around with it. Benchmarking data is a great driver for change and quality improvement, and also a way to show people how great their performance is.

“From a medicines management perspective, its greatest benefit will be the accessibility. With almost Google-like simplicity, OpenPrescribing gives everyone the ability to explore prescribing data.

“I also feel that that it could positively change the relationship between commissioners and clinicians: from one where clinicians see the data that commissioners choose to show them to one where they can see whatever data they choose, and then discuss this with commissioners in a proactive way.”

Only the beginning

Peter Brindle, Commissioning Evidence-Informed Care Lead at the West of England AHSN, says :”We are really pleased that OpenPrescribing has been so well received by Clinical Commissioning Groups and others, however this is only the beginning. OpenPrescribing will have greater functionality added to it over the coming months making it an even more effective tool to help practices understand their own prescribing.  The major area of activity will be to work with other Academic Health Science Networks and their practices so that OpenPrescribing is used to maximum effect.”

Find out more

More information about OpenPrescribing is available here and you are encouraged to ‘play’ with the data at OpenPrescribing.net

Developing a shared approach to evaluation in the West

How can we meet the call for more appropriate and robust evaluation? How do we generate more rigorous and relevant evidence? These were some of the questions explored by more than 30 people with an interest in evaluation, including commissioners, researchers and the public, at a workshop in December organised by the West of England Evaluation Strategy Group.

The interactive workshop explored the principles of pragmatic evaluation, and was led by Dr Peter Brindle, Leader for Commissioning Evidence Informed Care at the West of England AHSN and Evaluation Lead at the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West).

It was jointly organised by CLAHRC West, West of England AHSN, Avon Primary Care Research Collaborative (APCRC) and Bristol Health Partners.

Peter set the scene of the workshop as a chance to learn, listen and discuss the opportunities and challenges for evaluation. He was clear that this was the beginning of a collaborative effort to create a shared common vision, strategy and, especially, an action plan for evaluation in the West of England with the potential for collaboration with similar initiatives across the country. He went on to provide his own reflections on why Evaluation is important, the barriers to evaluation and some of solutions going forward, explaining that we need to: “Choose the right tool for the job whether it is quality improvement, evaluation or research.”

The key note speaker for the day was Professor Jo Rycroft-Malone, Director of the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme.  Jo described some of the challenges, opportunities and implications of pragmatic evaluation for the Programme. These included the implication for research methods, the need to agree what is ‘good enough’ evaluation, how to bridge the gap between those knowing and those doing, and what the rules of engagement are.

Lunch was followed by round table discussions on the following topics:

  • How do we best involve patients, carers and the public in evaluation?
  • How do we ensure that evaluation is of value to health and social care?
  • How do we build a culture of evaluation?
  • How do we create an ethical approach to evaluation?
  • How do we make the trade-off between rigour and relevance?

These table sessions inspired a broad range of discussions and reflections as well as a chance to share good practice and innovative ideas and solutions. These sessions were fed back to the room for further discussion. Themes emerging included the need for:

  • genuine and early co-production in evaluation
  • good early evaluation planning with all the right stakeholders and information
  • development of capacity, skills and understanding of evaluation
  • both rigorous and relevant evaluations.

There was also interest in the Researcher-in-Residence model being driven by Martin Marshall at University College London, Peter Brindle through his work at the Avon Primary Care Research Collaborative and Lesley Wye at the University of Bristol. This was acknowledged as an excellent way of bridging the ‘know-do’ gap and supporting putting evidence into practice.

The final step involved participants making a commitment to action as a result of the workshop discussions, whether something they personally intended to do or that they would take back to their organisation. A large number of actions were pledged and these will be pulled together and followed up in the coming weeks. Examples include:

I am going to “lobby for equal status of evaluation and research”

I am going to “ensure evaluation is embedded in transformation at the outset”

I am going to develop a “key guidance sheet”

Dr Peter Brindle said: “I feel that the event has helped to create an energetic and supportive community of action in the West of England to overcome the barriers to integrating evaluation into service change and innovation.”

The organisers would like to say a big thank you to all those who participated for their excellent contributions and commitment to actions to help drive this agenda forward.

The full workshop and evaluation report is being pulled together and will be available in the coming weeks. This report will be used to inform the future vision, strategy and action plan for evaluation across the West of England.

For more information or to get involved contact Jo Bangoura, Evaluation and Commissioning Lead on j.bangoura@nhs.net.

New OpenPrescribing platform aims to save the NHS millions of pounds and improve patient safety

A new online prescribing platform which enables the speedy analysis of prescriptions across the country for the first time has the potential to save the NHS millions of pounds, while ensuring that patients are given the best medication for their conditions.

Until now data relating to patient prescriptions by General Practitioners has been published on a monthly basis by the Health and Social Care Information Centre (HSCIC). The dataset amounts to 100GB and there are around four million rows for each file, making it very time consuming and challenging to access and analyse.

The platform has been established to make the significant amount of prescription data much more accessible and usable for the benefit of the healthcare community and patients. With support from the West of England Academic Health Science Network, it has been co-developed by Anna Powell-Smith, a computer programmer specialising in data analysis and visualisation; and Ben Goldacre, doctor, author, and Senior Clinical Research Fellow at the Centre for Evidence Based Medicine in the Department of Primary Care Health Sciences in the University of Oxford.

“CCGs and practices can now easily compare themselves with others, and this can trigger ideas for projects to improve patient care and reduce waste. They can also ensure that medications, which should be used for certain conditions as stipulated by NICE guidelines, are being prescribed and less effective medicines are not.”

OpenPrescribing.net is available online for all to use, free of charge. Target users include clinicians, Clinical Commissioning Groups, patients, the policy community, the media and researchers. It enables users to turn complex data into simple graphs at a touch of a button, to reveal how much of any drug has been prescribed at both CCG and the GP practice level

Its significant potential lies in its ability to spot patterns and major variations in prescriptions that can indicate opportunities to enhance patient safety through medications that are being commonly prescribed, as well as bringing about much needed cost savings by using less costly but equivalent medicines, which are shown to be popular in some areas of the country but not others.

Highlighting variations

The platform has already revealed a number of variations across all CCGs. For example, the use of branded statins relative to the more cost-effective generic versions varied eleven-fold between the highest and lowest prescribers.  Within one CCG this difference was in excess of 40 fold between practices.  Similarly, across CCGs there is a 45-fold variation in the amount of newer oral anticoagulants prescribed compared with the use of warfarin – the traditional treatment.

Said Ben Goldacre: “This platform makes complex data easily accessible. You can drill right down to the prescribing behaviour of individual GP practices, and all in the space of seconds. OpenPrescribing.net can help identify where there are variations and specific trends which could present opportunities for huge cost savings, or better prescribing. However it is important to be cautious in interpreting the data, and we have provided advice around this issue on the site itself. We’ve been delighted to have the assistance of the West of England AHSN in making this service freely available to everyone in the country, and we look forward to increasing the functionality of OpenPrescribing and delivering similar products on other datasets.”

Easy comparisons

Added Peter Brindle, Commissioning Evidence-Informed Care Lead at the West of England AHSN: “Ever increasing pressures on our healthcare system has led to a major drive for innovation in how the health services go about their daily business and to underpin new models of healthcare delivery with evidence.

“This is exactly what we have set out to do with OpenPrescribing and the potential of this approach is vast. CCGs and practices can now easily compare themselves with others, and this can trigger ideas for projects to improve patient care and reduce waste. They can also ensure that medications, which should be used for certain conditions as stipulated by NICE guidelines, are being prescribed and less effective medicines are not.

“Furthermore patients can use the platform to see how widely the medications they are taking are being prescribed by their practice and how that compares with other practices.

Data into action

Commented Anna Powell Smith: “Currently anyone wanting to query the prescription data from the HSCIC must load it into their own data tools first, which takes time and technical knowledge.

“It also only offers aggregate views so users cannot query individual practices and drugs. We want to get the data into action with this platform and encourage users to spot trends, develop hypotheses and test interventions.”

OpenPrescribing has been launched initially as a beta version so as to gain initial feedback from clinicians, CCGs and patients.