Hinchingbrooke Hospital is a Diagnostic pilot site for the NHS Lung Improvement Programme, providing direct access from local GP Practices to Respiratory Physiology. Hitherto, patients have been referred to Respiratory Clinic; most have Pulmonary Function Testing in a linked appointment on the same day. An audit of these patients showed 30% of referrals were immediately discharged back to the GP and could have been diagnosed and managed in primary care (estimated total saving of £10 000 a year).

Aims for the LIP service More accurate diagnosis of respiratory disease in primary care. More appropriate management pathways for respiratory patients, with enhanced access to smoking cessation services, COPD respiratory nurse specialists and pulmonary rehabilitation services. Ultimately, this will result in a reduction in hospital admissions due to better diagnosis and management in primary care. The aim was to reduce referrals to the Chest Clinic by 25%. To provide a quality service to the GPs and patients.

Methods Referrals for pulmonary function testing were received directly from Primary Care. Quality assured tests were performed: spirometry, gas diffusion and static lung volumes. At the point of testing, patients received detailed information regarding their results and diagnosis from a trained respiratory physiologist, giving an opportunity to have one to one conversations regarding fears or concerns about their diagnosis. Tests were reviewed by a respiratory consultant and a fully interpreted report Faxed to referring team. If Chest Clinic referral was advised, the cost of the services was deducted from the Chest Consultation tariff. Therefore the service is at least cost neutral.

Results (See Abstract P105 table 1).

Conclusions This service has been successfully set up, with a steady referral stream of patients from primary care. The main difficulty encountered has been awareness levels in primary care, despite promotion through standard channels. Outcomes show a high level of satisfaction with the service from both patients and GPs. 75% of patients who used this service have subsequently been managed within primary care, with an estimated cost saving of £1800 to the health economy.