Transcript Allergy: The Primary Solution

Allergy: The Primary Solution
Dr M Doyle
General Practitioner
29 September 2010
The problem…
• 20 million patients in UK with allergic disease
• Common presentations to primary care
– Asthma
– Eczema
– Allergic Rhinitis (Hay Fever)
– Food allergy
– Perceived allergy
29 September 2010
The problem…
• GP training in allergic disease
– Format of vocational training schemes
– “On the job” training
– Guidance has been historically limited
– Availability of testing
• 74% GPs felt they did not have the necessary skills
or training to treat allergy
• NASG survey 2008
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The problem…
• Lack of specialist allergy services
• Consultants with specialist interest – not ring-fenced for
allergy
• 71% GPs rated NHS allergy provision as poor
– NASG Survey 2008
• Patients often use other avenues
• Alternate testing services
• Complimentary medicine
• Can lead to misdiagnosis and confusion for both patient
and doctor
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The cost
• Direct cost to NHS pa = >£1 billion
• GP consultation costs alone = £211-311
million pa
• GP prescribing cost £0.7 billion
– 2006 DoH figures quoted in the RCP report 2010
29 September 2010
Mr H
A short case history
29 September 2010
Mr H
• 64 y o man
– Nasal polyps and
asthma
– Multiple courses of
steroids and
medications
– 9 surgical
polypectomies 19982009
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Mr H
• Diagnosed with salicylate hypersensitivity in
2004 by ENT surgeon
– No dietetic support
– No suggestion of onwards referral
– Patient and GP unaware (only recorded in
hospital notes)
• Ongoing surgery until 2009
29 September 2010
Mr H
• Diagnosed (again) with salicylate
hypersensitivity in 2010
• Now under tertiary allergy service
• Awaiting next polypectomy…
29 September 2010
Still not meeting the unmet need
• RCP/RCPath 2010
– Following up from original report 2003
– Identified little progress in improving
service provision
– Overall poor education in primary care
regarding allergy
– Differing opinions on role of GPwSI –
numbers identified as very small
29 September 2010
So where are we now?
• New guidance
– NICE: Food allergy, Anaphylaxis and Drug Allergy
– BSACI guidance
– PCRS/PCDS
– Other international guidance
• Impact of guidance on primary and secondary care
– Guidance fatigue
– Monitoring
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Priorities
• GP education
– Still hit and miss, depending partly on geography
– Post-graduate training available but requires
significant time and motivation
• Allergy should form part of all vocational training
schemes
– Allergic disease split in current GP curriculum to
multiple areas
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Priorities
• More funding for specialist services
• CCG engagement
– Difficult to find funding for new services
when existing ones are struggling
– Reallocation?
• Still variability in coding
29 September 2010
Solutions
• Quality and Outcomes Framework
• Commissioning
• Hub and spoke models
• Accreditation of the GPwSI
• Wider availability of appropriate testing
• All would help triage and improve patient journey
29 September 2010
Prof Don Berwick
• A promise to learn – a commitment to act
– Improving the safety of patients in England
• National Advisory Group on the Safety of Patients in
England August 2013
• “The most important single change in the NHS in response to
this report would be for it to become, more than ever before, a
system devoted to continual learning and improvement of
patient care, top to bottom and end to end.”
29 September 2010
“I felt such relief. Having spent what feels like years
asking for help, suddenly someone seemed to be
listening.”
29 September 2010