'A breath of Fresh Care' - Addressing a Critical Healthcare Gap in the Armagh & Dungannon Area.
Project overview, including who was involved in the project
Before the hub, patients faced diagnostic delays of up to 90 weeks due to longstanding challenges in primary care, exacerbated by the COVID-19 pandemic. Contributing factors included a shortage of trained staff, outdated equipment, a lack of standardised processes and no direct GP pathway into secondary care for diagnostics. The physiologist led hub was developed to address these issues by delivering advanced diagnostic tests 3 days per week directly into a rural community. Tests such as transfer factor (DLCO) and FeNO enable earlier and more accurate detection of respiratory conditions, facilitating quicker diagnosis, earlier treatment and better quality referrals into secondary care. This project is innovative as the first to offer enhanced lung function testing in primary care using mobile equipment. Transfer factor testing provides objective data on gas exchange efficiency, detecting conditions such as emphysema and interstitial lung disease earlier than spirometry alone. The implementation of DLCO in primary care was based on research by Sylvester et al, 2021, who found that 37.8% of patients with normal spirometry had abnormal DLCO measurements, meaning that we are missing these patients. This project is being used as a proof of concept to inform Respiratory Diagnostic pathways in NI. The aim is to reduce multiple attendances at the GP and reduce respiratory admissions through earlier detection and better management of respiratory diseases.Project outcomes/impact
Over 550 people have been assessed in the hub in 22-months, with current waiting times reduced to approximately 12-weeks. Only 8.5% required referral to secondary care; the remaining 91.2% received high-quality investigations and personalised care within primary care. Of these, 380 people received a definitive diagnosis during their first visit: 27.4% with asthma, 22.5% with COPD and were established on trials of treatment quickly. 49.7% had normal lung function on that occasion and were discharged back to their GP with recommendations for follow up.Data shows that approximately 45% of our patient cohort had abnormal DLCO with normal spirometry, mirroring the data by Sylvester et al. These people were identified and referred promptly for further investigation, enabling earlier diagnosis, preservation of lung function, and improved quality of life.
This project is funded solely by the Armagh and Dungannon (A&D) Federation, with no central funding to date. The A&D Federation is a community interest company run by its GP members to support 22 practices in the Armagh and Dungannon area of Northern Ireland. Despite funding limitations, the initiative has transformed respiratory diagnostics in the region, as evidenced by measurable improvements in access, accuracy, and care delivery.
If you were to run the project again, what would you do differently?
Initially we established a mobile diagnostic hub model to deliver advanced lung function testing across 22 GP practices. By hosting the hub within local practices, the aim was to improve accessibility, reduce waiting lists, reduce travel burden, and enhance patient engagement. However, despite the proximity of testing to patients’ homes, the service experienced persistently high Did‑Not‑Attend (DNA) rates, averaging 18% and peaking at 25% in some months. A quality improvement (QI) review identified that the decentralised administrative processes across the 22 GP practices created significant operational variation. Practices reported that managing appointments for the mobile hub added to existing workload pressures, with no designated staff allocated to refill cancelled slots or monitor non‑attendance. Additionally, each practice operated its own appointment‑booking and reminder system, resulting in inconsistent communication with patients and a fragmented patient pathway. These factors collectively contributed to high DNA levels and under‑utilisation of clinical capacity.In response, the service transitioned from a mobile model to a static lung function hub located within a single primary‑care site in the Armagh and Dungannon area. This enabled centralisation of booking processes and the introduction of a dedicated administrator responsible for scheduling, cancellations, reminders, and day‑to‑day coordination. Standardised workflows and consistent patient communication were implemented to streamline access and improve service efficiency.
Following centralisation, DNA rates significantly reduced from an average of 18% to 9%, demonstrating the impact of coordinated administration and standardised processes. Patient experience data showed strong support for the model, with 100% of surveyed patients reporting that the location of the static hub was “convenient,” reinforcing that accessibility was retained despite the shift away from the mobile design. We are currently implementing an AI‑supported appointment scheduling system designed to automate reminders, optimise slot utilisation, enhance patient engagement and reduce waste further.
Advice you would have for others undertaking the same type of project.
Consistent communication with designated staff in practices is essential for smooth operations especially when implementing changes and improvements to the service.Developing an innovative approach to diagnostics at the earliest point in primary care requires input from stakeholders across a range of disciplines in primary and secondary care to streamline existing pathways. Making contact with key stakeholders early is essential in the success of the service.
Continuous data collection is essential when implementing and monitoring change. In order to be able to scale a project like this up you need a sound evidence base and be continually seeking ways to reduce waste and enhance patient experience.