In response to our survey, Integrated Care Systems from across the country shared how they are rolling out spirometry and FeNo testing. They also told us about their education programmes for healthcare professionals.
Please also see the sections on spirometry and children + young people.
Birmingham + Solihull
Most impactful intervention: We have only just started our respiratory programme following appointment of the Respiratory Clinical Lead in July 2024. We are prioritising urgent care for winter, and have 4 workstreams on PR, oxygen and diagnostics which are in set up.
Bristol, North Somerset + South Gloucestershire
Most impactful intervention: Health Innovation Network's work with General Practice to start FeNO testing. LMC/ICB Training hub working to restart spirometry. Funded equipment and improved access to education.
Rejuvenated spirometry in General Practice. Resources developed for Primary care staff. Training programme available.
Buckinghamshire, Oxfordshire + Berkshire West
Most impactful intervention: Spirometry testing recovered and made available to 100% of BOB population in 2023/24 via primary care and CDCs.
Most impactful intervention: Oxford Breathlessness Pilot (Nov 2023-Mar 2025) – enabled streamlined diagnostics and MDT review/diagnosis for breathless patients in Oxfordshire.
Most impactful intervention: CYP Asthma – identifying and focusing on priorities via the CYP Asthma Care Bundle: setting up BOB CYP Asthma Network. Inclusion of CYP within the BOB ICB Spirometry and FeNO LCS 2024-27. CORE20PLUS5 CYP – has been a key driver of inequalities work relating to CYP Asthma.
All-age Spirometry and FeNO Locally Commissioned Service (LCS) for primary care in place as of 1st July 2024.
Cheshire + Merseyside
Most impactful intervention: Provision of RN funds to launch new spirometry services in Places where there was no service.
Linking TLHC CT scans with spirometry in TLHC sites from April 2024. Securing funding from Pharma for clinical review of patients post-spirometry in key target Place with greatest backlog of diagnosis. RN delivered education programme for late 2024.
Dorset
Because of a historic contract variation with primary care, we were able to restart spirometry quickly after COVID, so it is available across the county.
Greater Manchester
Most impactful intervention: Spirometry and FeNO - We have been leading a piece of work to get spirometry and FeNO commissioned. This has met barriers after barriers. The work done however has managed to restart spirometry in all but one locality in GM. There is now a task force set up with senior commissioning and finance colleagues to get this into GM Commissioning intentions. The work done has already put spirometry and FeNO in the Joint Forward Plan, Primary Care Blueprint Implementation Group, and also within Diagnostics and Pharmacy Partnership Group.
Most impactful intervention: Respiratory Deep Dive done across GM has given respiratory some momentum and a respiratory oversight group has been set up to oversee programs to do with Early and Accurate Diagnosis, Pulmonary Rehabilitation, Asthma and COPD, ILD and sleep.
Approach taken for spirometry and FeNO and Respiratory Deep Dive.
Hampshire + Isle of Wight
Most impactful intervention: NHS Hampshire and Isle of Wight commissioned spirometry in primary care via a Locally Enhanced Service (LES). Consistent access to spirometry in primary care has increased the number of tests which will be carried out. It is estimated that around 15,000 spirometry tests will take place in 2024/25 in primary care. Spirometry in Community Diagnostic Centres. Increasing capacity and access to spirometry has increased the number of tests which will be carried out. It is estimated that over 4,000 spirometry tests will take place in 2024/25 in Community Diagnostic Centres.
Kent + Medway
Most impactful intervention: Our spirometry LES was one of the first to be started in the country and we are at above pre-pandemic levels of spiro.
Lancashire + South Cumbria
Most impactful intervention: Breathlessness New Model of Care leading to spirometry available in community (2025/26)
North Central London
Most impactful intervention: Accurate diagnosis: When restarting the service in late 2023, we identified a high-risk cohort of adult patients. We worked with primary care to set up Respiratory Diagnostic Hublets where this cohort could get tested. This was to address the number of both the undiagnosed and the misdiagnosed. This project enabled NCL to work as an ICS bringing in all partners for all levels of care. It helped us create stronger links between ICB, primary care, secondary care, community health providers and the CDC. We are moving towards a PCN or neighbourhood model, bringing care closer to patients’ homes while ensuring the highest standards of care. The establishment of designated RDHs as part of the patient pathway, significantly simplify each provider’s role within this and minimises misallocation of system resources. It will also be the first time we are able to consolidate a diagnostic service for both CYP and adults.
North West London
Most impactful intervention: We now have respiratory diagnostic hubs live in all boroughs, to provide timely, quality assured spirometry and diagnosis for patients with breathlessness and other respiratory symptoms by improving access to quality assured diagnostic tests and specialist support. Hubs are meeting NHS England clinical guidance on wait times, with an average waiting time of 19 days across North West London. Feedback from patients has been overwhelmingly positive.
Somerset
We have tried to optimise use of regional funding for spirometry training and taken advantage of getting FENO into the area (funded in the same way as spirometry).
South East London
Most impactful intervention: Accurate Diagnosis: 2 boroughs within SEL developed a successful bid for a respiratory diagnostic pathway for adults and children through a partnership between secondary and primary care where there had previously been inequity in service provision across the 2 boroughs.
Respiratory Diagnostic service provision within an addiction clinic to enable diagnosis of those patients that do not access healthcare in the traditional way.
South West London
Most impactful intervention: CDC pathway for Croydon patients to access quality assured spirometry. Non recurrent funding to other places for community spirometry.
Wandsworth spirometry service.
South Yorkshire
Most impactful intervention: Movement towards a proactive population health management and multi morbidity approach to identify patients’ greatest needs and then supporting patients with evidence-based care and support. Starting to use segmentation and risk stratification approaches.
Centralised spirometry.
Note: review dates refer to the page content rather than the data visualisations