Detailed programme information

The South West AHSN has driven the regional implementation of Fractional exhaled Nitric Oxide (FeNO) testing in primary care.

Fractional exhaled Nitric Oxide is a point-of-care test which measures the amount of nitric oxide in a patient’s breath to increase the accuracy of asthma diagnosis. High levels of this gas can be a sign of the chronic condition, which affects more than 5.4 million people in the UK (asthmaandlung.org.uk). 

 In 2020, it was noted that FeNO had lower-than-expected patient access, presenting an opportunity to improve uptake and support the NHS Long Term Plan’s ambition of improving early and accurate diagnosis of respiratory conditions by embedding FeNO testing in primary care. 

As a key partner of NHS England’s Accelerated AccessCollaborative (AAC), the AHSN Network has supported the rollout of FeNO testing to improve the asthma pathway in England as part of the AAC Rapid Uptake Products (RUP) programme. 

The national FeNO programme sought to provide 50% of Primary Care Networks (PCNs) with access to a FeNO device. As part of this programme, the South West Academic Health Science Network has successfully introduced FeNO testing in GP practices across the South West, ahere it has been embraced by staff and patients alike. 

The national Fractional exhaled Nitric Oxide (FeNO) programme closed on 31 March 2023. Our local project here in the South West, alongside the national programme, has made substantial contributions to the transformation of asthma care in England, while significantly increasing the access to and adoption of FeNO.  

Local outcomes  

Prior to the project, FeNO was not largely available in primary care settings in the South West.  

With funding from former Devon Clinical Commissioning Group, the South West AHSN and the Southwest Respiratory Clinical Network supported the adoption of FeNO testing across the region as a part of the national RUP programme. 

Training was given to clinical staff in local PCNs. We hosted four collaborative forums, providing a virtual space for participants to discuss clinical or practical questions about implementing FeNO.  

As a result of our work:  

• 50 machines have been distributed across 34 PCNs in Devon, Somerset, Cornwall and the Isles of Scilly (see Fig 1) 
• 57% of the South West’s PCNs are now able to offer FeNO testing 
• The numbers of patients in the South West receiving a FeNO test rose from 98 in April 2022 to 2,408 in November 2022.** 

Figure 1: The distribution of FeNO machines used by GP practices across Devon, Cornwall, the Isles of Scilly and Somerset. 

In a survey of 13 surgeries, 100% of practices found the FeNO machines extremely easy to set up. From these surgeries, 54 patients had received an asthma diagnosis following their FeNO test. 65 patients had their medication increased as a result of their test and 70 patients experienced no alteration, whereas nine people had their medication reduced and two had been taken off medication completely.*** 

“Sometimes new ways of working can cause issues, but FeNO has been really embraced by staff and patients.” 

GP, South West

You can read more about the impact of the project in Devon, Somerset, Cornwall and the Isles of Scilly here. 

National outcomes 

The full impact of the programme is still being finalised however interim data shows that between April 2021 and March 2023:  

• An estimated 190,818 additional patients benefited from diagnostic FeNO testing across England.  
• 33 Pathway Transformation Fund projects were completed to support wider adoption of FeNO  

For the clinical workforce delivering asthma care the programme has supported learning, training and development.   

• More than 4,900 hours of specialist training was delivered to upskill those providing asthma care 
• 722 people attended webinars and learning collaboratives related to FeNO 

• The FeNO online resource toolkit has been accessed more than 13,500 times 

Next steps 

Training toolkits   

Toolkits, training modules and other resources created during the programmes will remain accessible to NHS clinicians following the end of the project. These include educational resources, information documents, podcasts, posters, learning modules and webinars. You can access them here.  

Annual services for FeNO devices  

Each NoBreath FeNO device will need an annual service. The device will let you know when this is due through its ‘servicing’ symbol. Your first annual service is free and was part of the package provided to for you by the South West AHSN. Please contact Intermedical with your device serial number to organise the annual service when it is needed: support@intermedical.co.uk.   

Please note that going forward, once your first annual service has been completed, all other servicing is to be funded by your surgery or PCN.   

Additional mouthpieces  

The South West AHSN have now distributed all spare mouthpieces. If you need more mouthpieces, these will need to be purchased by your surgery or PCN.   

Respiratory care  

Learning from the AHSN programme is being fed into the development of NICE/SIGN/British Thoracic Society asthma guidance, expected in 2024, offering real world insights to implementation considerations.  

The AHSN Network is now transitioning to support healthcare inequalities as a national priority as part of NHS England’s Innovation for Healthcare Inequalities Programme (InHIP). Building on the transforming asthma pathways work, a number of AHSNs will support the respiratory aspect of the NHS England Core20PLUS5 approach, continuing to utilise the implementation and educational resources developed for the FeNO national programmes.  

Contact  

If you have any questions, please contact Programme Director Steve Johnson-Wood: steve.johnson-wood@swahsn.com.  

 **Data source: supplier sales data provided by IRLS Analytics. 

***There are limitations to the data due to incomplete information for three to four practices responding to medication changes.