The national FeNO programme has now closed (end March 2023).
You can read the programme's national impact report here .
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 AACRapid Uptake Products (RUP) programme.
Fractional exhaled Nitric Oxide (FeNO) testing - is a simple, non-invasive test to measure the amount of nitric oxide in an exhaled breath – a biomarker for airway inflammation. FeNO testing can improve patient care by contributing to a faster and more effective asthma diagnosis when used alongside a detailed clinical history and other tests. It can also be used to monitor patient response to asthma treatments.
In 2020, it was noted that FeNO testing had lower-than-expected patient access, presenting an opportunity to improve uptake and support the NHS Long Term Plan ambition of improving early and accurate diagnosis of respiratory conditions by embedding FeNO testing in primary care and increasing access to asthma biologics through improved clinical pathways.
The national FeNO programme focused on collaboration at a national, regional and local level across healthcare systems, industry partners, patients, and the community and voluntary sector to integrate FeNO testing into everyday clinical practice.
We worked within our local systems (Hampshire and Dorset) to support asthma pathway improvements by taking a pathway-based transformation approach. AHSNs provided clinical and transformation leadership, shared best practice and developed education and implementation materials for those involved in providing asthma care.
A package of educational resources was created to support FeNO implementation - comprising information documents, podcasts, posters, learning modules and webinars. The toolkit was designed in a practical way to support teams adopting and sustaining the use of FeNO testing.
The programme aimed to improve patient care and outcomes through enhanced access to diagnostics and treatments for severe asthma. The full impact of the programmes is still being finalised however interim data shows that between April 2021 and February 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.
In early 2022, NHS Dorset (formerly Dorset CCG) decided to invest in FeNO testing at a system wide level enabling all primary care networks (PCNs) to access the test. We also supported the implementation of FeNO testing in a number of PCNs across Hampshire.
The national FeNO programme has now completed and have made substantial contributions to the transformation of asthma care in England while significantly increasing the access to and adoption of FeNO. 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.
There are opportunities to continue this work and improve asthma care by enhancing rollout of the innovations and ensure more patients can benefit. The FeNO toolkit, training modules and other resources created during the programmes will remain accessible to NHS clinicians following the end of the AHSN programmes.
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.
Links & Resources
FeNO toolkit: https://wessexahsn.org.uk/feno