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Aleksandra Gawlik-Lipinski , a respiratory nurse specialist working in general practice in south London , believes respiratory care is ' falling behind ' other specialties in the UK . Here , she tells Nursing in Practice that nurses need more support and better access to diagnostics if they are to help improve care for patients .

Where are we with respiratory care in general practice ? I think that , collectively , we are falling behind compared with other specialties . Training across the general practice team may not always be adequate – for GPs , nurses , physician associates , healthcare assistants or pharmacists . And from a nursing point of view , respiratory care is of course only a part of what nurses are dealing with .

We also know the levels of respiratory care provided vary too much from practice to practice , and from region to region , which is increasing health inequality in the UK . As it stands , we do not have the required standard level of respiratory care across the country .

Although organisations are good at providing guidelines and competencies – such as the Primary Care Respiratory Society ( PCRS ), Association of Respiratory Nurse Specialists ( ARNS ) and the British Thoracic Society ( BTS ) – training is often not readily available to clinicians and I think that is a big problem .

Workload in general practice is still high after the pandemic , and patients may not always be getting their annual reviews , or these are being done over the phone , which is not always appropriate . Patients also may not be reviewed on time after asthma or COPD exacerbations and we have problems with making timely diagnosis .

In my opinion , children – particularly young children – and young people , are often not properly diagnosed

with asthma . I sometimes observe a hesitancy to diagnose a child with asthma , which can delay treatment . The child may only be given one inhaler – the reliever – rather than a reliever and a preventer .

That can lead to them having asthma attacks , resulting in emergency presentation or admission . Another big problem with the paediatric population is the limited access to diagnostics in primary care , and the pandemic has played a big role in that . Before Covid , practice nurses were very much involved with spirometry , and then everything changed .

We do now have the new respiratory hubs , but the waiting times to be seen are very long . Locally where I practise , my patients are waiting four months or more for an appointment .

It ’ s all about the capacity and the funding that is not necessarily there for the NHS , but at the end of the day patients are suffering because they are not diagnosed in a timely manner because we don ’ t have ready access to the diagnostics .

With COPD , we ’ re typically waiting for a diagnosis before treatment will be initiated , resulting in a delay to treatment , which means the condition may deteriorate in the meantime .

Will additional funding for diagnostic centres help ? The respiratory hubs are a good initiative , although I think we need more of them . What ’ s great is that the clinicians working there are performing quality-assured spirometry . They will be registered with the Association for Respiratory Technology and Physiology , which is really important because every now and then we do come across spirometry traces that may not have been

GETTY : MARTIN PRESCOTT