New evaluation shows FeNO testing project is supporting better asthma diagnosis across Gloucestershire

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

Read more about FeNO testing with our patient stories and free implementation resources.

The Leadership Series – Commissioning Musculo-Skeletal Care

The concept of the Leadership Series is to bring specific senior commissioners together from across the seven CCGs to focus on areas of common challenge, facilitate learning, spread knowledge across the patch and identify further areas to explore collaboratively.

Five Leadership Series meetings have been scheduled to date: three in 2016, covering the topics of ‘Primary Care Demand and Flow’, ‘Commissioning Musculo-skeletal care’ and ‘Commissioning Diabetes Care’, and two of which were held in 2015 on ‘Using Evidence & Evaluation in Commissioning’ (February 2015) and ‘Exploring different approaches to CCG prioritising and de-prioritising strategic initiatives’ (May 2015).

The Musculo Skeletal Care event was held on 19 April with 17 attendees from all seven WEAHSN member CCGs and two UWE researchers.  Feedback from the meeting from delegates was very positive, with a request to meet again in early September, in advance of the CCG business planning timetable.

Feedback after the event included:

“An excellent opportunity to share work in a supportive environment.  I have a far better understanding of what is happening locally and who is involved.” GP Clinical Lead

“Between us we can transform MSK; we need to coordinate much better.” Elective Care Lead

“Very helpful to see what is happening on the patch.  Good to combine clinical perspective with management transformation.” GP & Clinical lead for Planned Care

“We are all grappling with similar issues and it feels a less lonely place now!  There is a collective motivation to embed transformation.”  Service Improvement & Development Manager.

“Useful to collaborate.  We are all trying to do similar things.”  GP Clinical Evidence Fellow

There was also agreement that a musculo-skeletal ‘community of practice’ would be helpful to electronically enable attendees to stay in touch.

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.