Can interstitial lung disease (ILD) be managed in local respiratory services?

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Introduction: In England, patients are referred to ILD specialised services to support diagnosis and management. Referrals have increased without additional workforce resource. NHS England have suggested delegation of ILD care to local respiratory services may improve earlier diagnosis, access to treatment and delivery of care closer to home. The service provision and workforce in local respiratory teams is not fully understood. Method An electronic survey was sent to 14 main referring centres in the southeast of England to ascertain service provision and workforce in our region. Results: 12/14 respiratory services responded. Local respiratory teams had an average of 5 respiratory consultants, ranging from 1 to 8; Only 2 services provided patients with ILD access to a respiratory nurse. 66% reviewed patients with ILD in dedicated clinics and multidisciplinary meetings (MDMs). In 2022, each respiratory service actively managed an average of 327 patients with ILD, ranging from 150 to 500. Waiting time from receipt of referral to first clinic appointment averaged 20 weeks, ranging from 2 to 52 weeks. The standard waiting time for lung function test was 12 weeks or more. All patients with ILD could access supportive care but commissioning of pulmonary rehabilitation, oxygen services and palliative care for patients with ILD varied. Conclusion: There are a number of challenges to sharing responsibility with local respiratory services, including inadequate respiratory workforce and limited access to supportive care services. To deliver equitable care closer to home, we need minimum standards of care in addition to a review of supportive services and workforce, according to caseload, required to meet them.

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