1.7 million people are living with COPD, and around 600,000 of those are living undiagnosed across the UK. This is due to huge backlogs and geographical inequalities to accessing spirometry – a basic diagnostic test. Spirometry used to be provided in primary care but inadequate funding and workforce challenges are leaving people without proper care and treatment, permanent damage to health, and unnecessary hospital admissions. This inability to diagnose those with lung conditions in an accurate and timely manner is a serious failure in need of a serious solution.
What the data shows
Nearly 85% of ICSs [27/32] who responded to the survey are now commissioning adult spirometry in primary care, with many doing so through a Locally Enhanced Service. It’s encouraging to see that ICSs who do not yet have ICS-level commissioning arrangements are working toward this.
Concerningly, the data from this survey shows that many ICSs do not have enough spirometry testing capacity to meet the demand. Only 8/32 respondents said they had enough spirometry to meet the demand of new referrals and to address any backlog, though there are distinct gaps in the data that these ICSs were able to produce, meaning that this assessment of appropriate volume may not be accurate.
It’s significant that most ICSs were not able to say how many spirometry referral requests were received and how many tests were performed in their area in the past year, either because this is not collected or not held centrally. This is a concerning gap in data availability and exposes a failure in commissioning and accountability that needs addressing at a national and ICS level.
Data on spirometry rates for children and young people can be found on the Children and young people page.
In the Diagnostics section you can find more examples showing how ICSs are rolling out spirometry testing across England.
What is Asthma + Lung UK calling for?
- 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.
- In the meantime, ICSs should prioritise the delivery of spirometry training to primary care clinicians, and establish a local funding mechanism so that spirometry can be delivered in primary care across England.
- Improve data collection and analysis across the care pathway to bring together primary and secondary data. Make high quality data publicly available to help ICSs target care where it is needed and ensure accountability.
Further information provided by the ICSs
We are actively looking at how to commission adult spirometry across the ICS.
Currently, there is some delivery in primary care in the ICS. Birmingham Community Health Care had some non-recurrent funding to provide spirometry across the ICB. This has now finished. There was a diagnostic hub in the East Locality, but the funding for this has now ended. SDSmyhealthcare, one of the GP Federations, has a community respiratory service. This is currently open to South Docs Services member practices across 9 PCNs in South Birmingham. This is currently unfunded since the ICB funding for the service ended.
Around one third of GP practices are providing some spirometry to their own patients but are not funded to do so.
The ICB commissions a community based PR service aimed at improving attendance and completion among targeted population cohorts.
Adult patients can be sent for spirometry in a secondary care setting at NWAFT but not CUH.
The source of funding, capacity provided and ongoing nature of funding varies from place to place.
Many different models around the 9 Places. These include: Place/CCG commissioned – 2 with full capacity and ongoing funding, 2 with inadequate capacity but ongoing funding. Funded on short term funds via Respiratory Network – 1 with good capacity, 3 with some but inadequate capacity. All have no ongoing funding. Hybrid – 1 area with a mix of predominant CDC capacity and minimal primary care capacity. 3/9 local CDC deliver spirometry and 1/9 commencing 2024. This covers a limited geographical area with no capacity at local CDC for most of the population.
Adult patients can be sent for spirometry in a secondary care setting only if the test is associated with a secondary care pathway.
- Bolton: Service commissioned in secondary care at Bolton hospital led by ARTP registered nurse. All GPs can refer. Each 1hr appt includes inhaler use, lifestyle questions etc.
- Bury: PCN model via GP Fed. All referrals into central hub and Fed manage/fill the clinics which run from 3 sites providing a 7-day service.
- Heywood, Middleton + Rochdale: Hub model with 1 each in Heywood, Middleton and Rochdale, hoping for live Sept/Oct. Funding only for 24/25.
- Manchester: No primary care commissioned offer. Working towards PCN model in negotiations with primary care providers.
- Oldham: Mix of GP practice & PCN models. 24/33 practices offering spiro to patients (Jun 2024). Local QA process in place.
- Salford: PCN model with 1 hub in each of 5 PCNs.
- Stockport: Services commissioned through Viaduct & is PCN model with 3 hubs plus potential satellites in more deprived areas.
- Tameside: GP practice model via locally commissioned service.
- Trafford: PCN model
- Wigan: External provider delivering service – all staff ARTP registered. Delivering across 5 locations with 1 more coming in Nov resulting in a 5 day per week service.
(Worcestershire only due to coding issues)
Work is underway to explore options for future spirometry provision in order to support robust and equitable provision across the ICS. Following agreement, there will be work at place to determine how it will be implemented, coupling provision from primary care with CDCs and Targeted Lung Health Check. Hull and ERY TLHC programmes now offer spirometry and we are currently running a standalone case-finding programme in Hull for those that missed out on spirometry during the pandemic. Funding includes NHSE spirometry monies for training and education and FeNO equipment.
No consistency across the ICS. From 2025/26, it will be in ICS GP quality contract.
Unfortunately, historically some patients have been referred to secondary care for spirometry testing. The ambition is for us to have Respiratory diagnostic Hublets in each PCN / Neighbourhood. Each GP would refer their patients to the RDH for testing and following the interpretation of results, only if needed would the patient be referred for further investigations to the CDC or Secondary Care.
We focused on diagnosing an identified high-risk adult cohort to restart the service. Services were established in all 5 boroughs in NCL. We are now transitioning to “routine referrals”. Some delivery in GP surgeries (PCN-based) and developing provision in Community Diagnostic Centre. Commissioning in development. Non-recurrent funding for Respiratory Diagnostic Hublets until April 2025. Working on long-term sustainable commissioning for the new financial year onwards.
Spirometry commissioning varies depending on locality/place. Not all localities/places have commissioned services. We are currently working on closing inequity and have developed a business case to support this.
Some places have PCN based model (Kingston); Croydon has CDC spirometry (direct access to GPs for COPD or asthma). Sutton & Merton have pilots with non-recurrent funding. Wandsworth is provided by community respiratory team who have been awarded non recurrent funding to boost their capacity.
There are currently a range of commissioning approaches:
- Around 50% of GP Practices and PCNs in SY continue to offer Spirometry for their practice lists as part of core contract
- In Doncaster delivery is currently via Primary Care Contract (General Practice)
- Barnsley and Sheffield are commissioning additional capacity to complement access via GP practice
- Targeted at patients who cannot access spirometry directly from their GP practice or PCN.
- Barnsley - commissioned from acute provider
- Sheffield - commissioned from GP Federation (start date Jan 2025).
- Rotherham commission a dedicated centralised spirometry service (hub and spoke). This is jointly delivered by the GP Federation and local NHS Trust (combined community / acute). The hub is co-located with the CDC and Community Respiratory service in a community location.
- Leeds: Diagnostic spirometry is not commissioned per se, there is a local Primary Care Enhancement Scheme which general practice delivers against for additional resources to include spirometry, ECG and phlebotomy. 2 CDCs currently offer spirometry in Leeds though long-term funding of these is yet unknown.
- Bradford: All practices provide spirometry as part of a LES. Practices are paid to perform and interpret spirometry. Delivery ranges across practices with some delivering the service at practice level whilst some at a PCN level. We are working closely with our partners in West Yorkshire to ensure we have an accessible, quality-assured service, equitable across our places.
- Wakefield: Spirometry is commissioned through WPPC (Wakefield Practice Premium Contract) who provide it from its premises for all patients who require them (or subcontract with another Wakefield Practice).
- Kirklees: Spirometry is delivered in Primary Care via a Locally Enhanced Service. We also have a direct access contract currently with one of our trusts to provide the spirometry service as we have a gap in take-up of the LES in the north of our patch.
- Calderdale: Community Spirometry Diagnostic Service in Calderdale is available to any patient registered with a Calderdale GP. It operates out of five hubs across Calderdale and offers daytime and weekend appointments.
Note: review dates refer to the page content rather than the data visualisations