Abstract
The Early Respiratory Diagnostic Project(ERDP) is focused on improving referral pathways for asthma, COPD and ILD by providing timely and accessible diagnostic testing in primary care for adults suspected of having lung conditions.This initiative aims to reduce respiratory admissions through faster diagnoses, and in turn reduce health inequities and ensure patients receive the right care, at the right time, at the right place improving patient outcomes.
Currently, spirometry in primary care is performed by practice nurses in each GP practice, but this model is unfunded and not part of the GP GMS contract. Additionally, spirometry services were suspended during the COVID-19 pandemic resulting in:
- five-year waiting time for referrals to secondary care
- Deskilling of nurses
- Lack of training
- Nurse retirements
Health inequalities are significant in the region, Armagh, Banbridge, and Craigavon Council ranks 207 out of 216 across the UK for the highest combined rates of emergency respiratory admissions and deaths (Asthma & Lung UK). The rate of respiratory admissions in the most deprived areas is nearly double that of the least deprived areas, as highlighted in the Department of Health NI’s Health Inequalities Report 2024.
We launched ERDH in the Armagh Dungannon area, offering advanced lung function testing in GP practices. This service includes tests such as carbon monoxide transfer factor, typically available only through secondary care, addressing the issue that 37% of patients with abnormal lung function may have normal spirometry results. This helps identify lung conditions early, improving long-term health outcomes.
The service also provides FeNO testing, which is shared between nearby practices on a rotating basis. It was developed by a multidisciplinary team and focuses on delivering high-quality, accurate testing at the point of care to enhance respiratory management.
We engaged all practices in the Armagh and Dungannon Federation, implementing a flexible model tailored to each practice’s needs. Additionally, we reskilled practice nurses who had become deskilled in spirometry due to COVID by offering spirometry updates, mentorship, education sessions, and 1-to-1 interpretation training.
The service is continuously monitored and improved through patient involvement, GP practice input, and ongoing audits to optimise workflow and efficiency.
Patient outcomes:
- 259 referrals
- 107 patients seen
- 20 new Asthma diagnosis
- 17 Airflow obstructions
- 30 normal lung function
- 69.1 % of patients treated in primary care
- 22.1% (13) further investigation in primary care
- 5.9% referred to secondary care
- 2.9% treatment amended in primary care
The current waiting list for the hub is 8 weeks, compared to 91 weeks in secondary care.
Patients with COPD and Asthma can be managed effectively within Primary Care when GPs are provided with the correct diagnostics.
Our project has reduced unnecessary referrals to secondary care. By proving the concept of this project, we will be in a position to bid for appropriate funding and expand this project across all 17 GP Federations in Northern Ireland.
This project is being delivered in partnership with Niox and NDD Medical Technologies.