FeNO testing is measuring the amount of Nitrous Oxide in the air you breathe out. Essentially its a marker of inflammation. If your lungs are inflamed it’s up if not they are ok. NICE recommends using FeNO testing in the diagnosis of Asthma. If its normal they either don’t have asthma – or it’s under control. Strangely despite the guidance, as far as I know, take up has been low. Perhaps this has been because the machines, while easy to use, aren’t cheap like a Peak Flow meter or even an FEV machine that many use for the QOF. Whats strange is locally none of the local hospitals appears to be offering it as a service either.
They are easy to use though – I run a clinical trials team at my surgery doing research studies and we did one involving FeNO testing – everyone loved it. It was easy to use and quick and quite a few of the doctors and nurses popped in and used up some of the test cartridges on checking themselves or their kids.
Now we all know that towards year-end despite being strapped for cash suddenly pots of money appear that need to be spent by tomorrow. Buying willing practices a machine each might be a good thing.
Not only is it used in the diagnosis but you can use it in the review of asthma as well. If when reviewing a patient their FeNO is normal (low) they are under control and it’s a good idea to reduce their medication. This is something we tend to be bad at. We often put medication up – as a patient complains of symptoms but we have a habit of leaving them as they are not reducing them. Obviously stopping medication is a huge cost saver. there are all sorts of economic models that claim all sorts of amazing ROIs but essentially if the machine pays for itself that’s great anything on top is a benefit.
We have had this idea on the shelf for a while and our CCG’s Medicine Mangement Lead has just won a pot of money to buy a load of machines based on this ROI and we are working out the best way to do this. The problem, once you have the money, is not the kit, its convincing GPs to take on another task. There is a feeling amongst some that this is yet another task GPs are being asked to take on from secondary care without any of the resource going with it. For example ECGs – there appears to be a tariff of around £46 per ECG done on an outpatients basis for a hospital yet many GPs do them for “free”. Often the machines were bought for a practice up front but the practice paid for the staff using them and then picked up the maintenance cost with no uplift in any budget to do the work. In some areas CCGs pay practices an enhanced service, to provide some primary care diagnostics, in others they don’t, often meaning there is a huge variation in practices that deliver the service. Some do as they feel its clinically worthwhile, or they have an interest, or they are a long way away from a centre, or it has other knock-on benefits for them. Some just refuse. Interestingly there is also an argument for centralisation – better-trained staff doing the procedure, or more harmonisation and standardisation in interpretation. The downside is sometimes you get a hospital orientated report, not one that is suitable for primary care. What it might be worth doing is top offering a return on savings made – though this can be difficult to agree in isolation from the rest of the finances.