Respiratory Specialist Review Service: Improving Access to Respiratory Expertise Through a Neighbourhood-Based Model of Care
Project overview, including who was involved in the project
Local need is shaped by wider determinants of respiratory ill health. Almost half of Birmingham neighbourhoods are among the most deprived fifth nationally, and local air pollution remains a significant contributor to respiratory morbidity, including high COPD prevalence and exacerbation risk.Access to objective diagnostics and respiratory expertise within primary care remains inconsistent, often resulting in delayed diagnosis of conditions such as COPD and avoidable secondary care referrals. In response, South Doc Services (SDS) established a Respiratory Specialist Review Service (SRS) to deliver community-based specialist assessment, diagnostics and treatment aligned to the NHS neighbourhood health model.
16 hubs across the city provide one-stop appointments offering spirometry, FeNO and specialist consultation. A linked COPD risk stratification programme, delivered by a specialist pharmacist, proactively identifies high-risk patients for optimisation and can refer directly into the diagnostic service and multidisciplinary team (MDT), ensuring timely intervention and exacerbation prevention.
SDS clinicians have access to primary care records, onward investigations and monthly MDT meetings with respiratory physicians. The model brings together Respiratory Consultants, GPs with a special interest, Specialist Nurses, Practice Nurses, Independent Prescriber Pharmacists and ARTP-accredited practitioners, with community physiotherapy input.
Patients, including those with suspected or confirmed COPD, can complete diagnostic work-up in the community and be directed to appropriate pathways, including specialist services where needed. The service strengthens system-wide collaboration and supports integrated step-up and step-down care.
Project outcomes/impact
In 7 months, over 100 practices across 29 primary care networks (PCNs) accessed the SRS, with more than 2500 referrals demonstrating rapid uptake, including significant demand for COPD assessment and optimisation.Average wait time of 48 days from referral to appointment compares favourably with secondary care. Over ~1700 spirometry and ~1100 FeNO tests have supported accurate diagnosis of asthma and COPD, enabling earlier intervention and medicines optimisation.
Hub utilisation remains high at 80–100% capacity across 16 sites, delivering ~157 sessions per month. Approximately 95% of patients are discharged back to their GP without onward referral, including many COPD patients managed successfully in the community through inhaler optimisation, exacerbation planning and risk stratification. Fewer than 5% require escalation to secondary care.
The linked COPD risk stratification programme enhances proactive identification of high-risk patients, enabling direct referral into diagnostics and MDT review, reducing exacerbations and unplanned admissions.
Practices using the service show reduced secondary care referral rates, shortening pathways and improving patient experience. The service aims to improve access, ensure patients (including those with COPD) receive timely, guideline-based care, and maximise secondary care capacity for complex cases.
Collaboration across the respiratory system has improved shared learning, with clearer escalation pathways and better alignment between primary, community and hospital teams.
If you were to run the project again, what would you do differently?
The project was mobilised in just 3 months. A longer lead time would allow more comprehensive engagement with practices, including education on COPD pathways, risk stratification processes, referral criteria and how patients can be directed into the pharmacist-led COPD programme and SRS.Advice you would have for others undertaking the same type of project.
Referral via eRS provides a clear and consistent route with defined criteria and triage.Strong engagement with general practice is essential, particularly to support early identification and management of COPD.
Clear communication and promotion help clinicians understand access routes, including direct referral into diagnostics and MDT via linked COPD risk stratification pathways.