Leading questions: Dr Sajid Nazir, clinical director in West Yorkshire on respiratory hubs

With this winter seeing some of the worst hospital admissions for respiratory illnesses in recent years, senior reporter Beth Gault speaks to clinical director of Viaduct PCN in West Yorkshire, Dr Sajid Nazir, about how the PCN set up a respiratory hub

Beth Gault (BG): How and why did you set up a respiratory hub?

Dr Sajid Nazir (SN): We’ve been running acute respiratory hubs in the area since December 2022 when there was the streptococcal outbreak.

It was initially for paediatric patients when there was some national funding for that. But in the last two years, that’s opened up to all ages with funding through the Urgent and Emergency Care Board, which is primarily based at our local hospital trust. They have some funding which you can bid for each year for the purpose of avoiding unwarranted hospital admissions.

In the last two years we have received this funding to run respiratory hubs. At the moment, it funds three clinicians to run three clinics across Huddersfield, where our PCN is based. It’s a mixture of GPs and advanced nurse or care practitioners running the hubs, but the majority are run by GPs.

Two PCNs administer it on behalf of all the PCNs in the area, but we have three hubs. There is also a similar scheme in North Kirklees, so we cover the whole ICB and any of the practices can book in.

Traditionally the clinics run in the afternoons which is usually when patients are told there are no appointments at surgeries, so they ring 111 or A&E sometimes.

BG: How long does the hub run for?

SN: We run the hubs for 15 weeks in the winter from 1 December, but this year we were able to secure additional funding from the system development fund (SDF) to bring that forward, so we started on 1 November, and it will be almost 20 weeks in total this year.

BG: How successful has it been within your local area?

SN: We’ve had 95% utilisation, so that’s almost all of the appointments taken up. This week it’s been 100%, meaning there’s no empty slots left over.

The clinic being fully booked tells you how much respiratory illness is out there. We know that practices would struggle to mop all of that up if we didn’t offer the clinic, and it would spillover to other services like 111 or A&E as well.

BG: How do patients book into the hub?

SN: 111 and A&E are able to book into the hub if needed, but we’ve hardly seen any bookings from them, mainly because they have existing processes. So for the most part, the patients are booked in by practice reception staff when they have respiratory illness symptoms.

We try and make it equitable for practices so everyone has a set of appointments and then when it comes to midday, any unused ones are opened up for everyone.

Clinics are held in the late afternoon, mainly because that’s when practices struggle with capacity and people are told to go elsewhere.

BG: Has the clinic reduced pressure in the system?

SN: Yes, of course. The feedback we have tells us where patients would have gone had they not been offered these appointments. Many of them would have gone to A&E.

But we’re also offering a significant number of appointments which are additional, so these patients would have either been seen as extras or asked to call the next day.

We have no doubt that there’s been reduced pressure on practices, but also on out-of-hours, 111 and A&E. We’re increasing capacity throughout the week, Monday to Friday, so the impact will be felt across all those areas.

We also monitor admissions from the clinic, which are quite low, so hopefully we’re intervening at the right time to prevent hospital admissions.

BG: Has this year been busier than previous ones?

SN: Definitely. Since the start of December there’s been a significant increase in attendance with these issues. We know that there’s been a lower uptake of flu and Covid vaccinations compared to previous years, and we’ve seen patients being hospitalised increasingly, rate wise and compared to previous years.

And I’m sure this will be replicated up and down the country. This winter has been very difficult. 

BG: Would you recommend it as a model to other PCNs?

SN: Absolutely. I think if the funding is there, it’s a great way to take pressure off staff. And most PCNs will have the mechanisms to set up these sorts of initiatives with existing infrastructure. What we’ve found is that it’s quite easy to make a case for it when you bid for these sorts of services, because you can demonstrate the effectiveness of the services.

BG: And PCNs are a good mechanism for this service?

SN: Absolutely. For all of the reasons including access, staffing, resilience, working together and data sharing. All of these things are already in place so you can set it up with minimal disruption.

BG: What’s the plan for the future?

SN: We are quite hopeful that the hub will continue. We’re on the third year now where this has been funded and recognised locally and we know the impact it’s had.

It makes a significant difference, so we hope it continues.