Respiratory care action plan draft: consultation report

Question 3: Early and correct diagnosis of respiratory conditions are a priority

• Commitment 1 – We will support respiratory health training and education for healthcare professionals by working with NHS Education Scotland and other partners to ensure that education and training on respiratory conditions is delivered/is available to healthcare professionals. We will support education to be available in a variety of formats to optimise accessibility
• Commitment 2 – We will improve equitable access to evidence based diagnostic tests by working with partners to reduce variation in the quality of spirometry testing across the Country and design pathways for complex respiratory function testing
• Commitment 3 – We will support consistent disease specific pathways and work with the sector to ensure they are embedded in the health services and partners

'Do you agree with commitments 1, 2 and 3?'

Option	Total	Percent
Yes	102	85.71%
No	3	2.52%
Don't know	6	5.04%
Not Answered	8	6.72%
Total	119	100%

A total of 111 people responded to this question, with 41 responses being expanded to include comments. Of those, a majority (102) agreed with the commitments on diagnosis, management and care with a minority (3) disagreeing or not knowing (6). A total of 8 people did not answer the question. To further breakdown the figures of those who responded:

• NHS (boards and organisations) 8
• Third sector organisations 13
• Private sector companies 6
• General public individuals 84

When considering the responses, a number of themes were raised: diagnosis, testing, treatment, self-management, staffing, training, public education, multi-disciplinary teams; and Covid-19. 

As evidenced by the number of 'yes' responses to the question, there was broad agreement that early and correct diagnosis is important. Several responses noted that earlier diagnosis can equate to longer survival with a better quality of life, so it is vital to limit delay.

Breakdown of the most common themes: 

Diagnosis

Calls were made for a standardised diagnostic pathway. In particular, some respondents felt that there is not currently a recognised standard of diagnosis of asthma, which can lead to a delay in treatment. The need for easier referral pathways for GPs was also noted.

Some respondents asked for clarification around what the early years diagnosis approach might be. Other respondents suggested the use of diagnostic hubs as a specific commitment, to allow consistency and accessibility (especially in remote or rural areas).

Testing

Some respondents highlighted a concern at limiting commitment 2 to spirometry testing only, with some respondents asking whether it should refer to all diagnostic tests. There was agreement that the quality of and access to spirometry testing needs to be improved, with examples given of differential diagnoses. 

Treatment

Responses that included references to treatment included issues such as the patient pathway, a greater need for a holistic needs assessment, greater emphasis on management of asthma, increasing in the number of check-ups, and linking primary and secondary care. The role of community pharmacy was also raised and how pulmonary rehabilitation could be delivered out with a hospital or outpatient setting.   

Self-management

Regarding self-management of conditions, the need for ongoing training for patients with respiratory conditions as well as education and support for families and unpaid carers were key issues raised by respondents. The importance of equipping health care professionals to support people with respiratory conditions to positively change behaviours and to promote safe use of inhalers where needed was important. 

Workforce

It was widely acknowledged that the first part of the Question 3 commitments overlap with the later commitments on workforce. 

Regarding Allied Healthcare Professionals, some respondents were of the view that increased use of pharmacists and pharmacy staff for testing would increase capacity, especially in areas with long waiting lists. It was also noted that common respiratory diseases should be included in the Pharmacy First list of conditions. Other respondents welcomed funding which has enabled pharmacists to train as independent prescribers, which allows a review when needed and changes to be made faster when required by the patient. 

At a national level, some respondents called for a chief medical officer national advisor for each of the five conditions and a Pulmonary Rehabilitation Champion within the Scottish Government, as well as a national advisory committee to ensure delivery of the Plan. 

Training

There was widespread agreement regarding the training of staff, with respondents noting that it is essential for the Plan to commit to ongoing education for staff, to allow them to build and maintain knowledge and skills, with ongoing training to help ensure consistency of referral and correct diagnosis. 

Training should not be limited however, with some respondents highlighting that Allied Healthcare Professionals should also have access to appropriate training. 

Multi-disciplinary teams

There was support for a multi-disciplinary team (MDT) approach, utilising skills across healthcare and providing consistent access. These teams would support the patient throughout their journey, ensure maximum benefit from medicines and support and minimise avoidable harm. 

Some respondents suggested that in order for an MDT approach to be successful, medical information should be available to all healthcare providers during the healthcare journey. An example of the multi-disciplinary team approach is the use of community pharmacists to perform asthma reviews; it was mentioned that patient outcomes have improved by including them in the management of respiratory conditions.

A chart showing phrases from the Q3 responses. Staff training had 19 mentions; MDTs had 7.

A chart showing phrases from the Q3 responses. Staff training had 19 mentions; MDTs had 7.