Clinicians could soon refer patients with respiratory infections to community hubs or virtual wards

For the first time, NICE draft guidance recommends that some patients with respiratory infections are referred to community respiratory hubs or virtual wards.

The move comes following the establishment of multiple Acute Respiratory Infection (ARI) hubs across the country, which are designed to relieve pressure on other parts of the healthcare system.

Reducing unnecessary hospital admissions

According to NHS England, many patients with breathing difficulties do not need to be treated in hospital, and can instead be looked after in the community.

Despite this, NHS England and UK Health Security Agency (UKHSA) Emergency Department Syndromic Surveillance reports from 2020-2022 show that acute respiratory infections are one of the most common reasons for emergency attendance and admission.

Respiratory problems are also one of the most common reasons for GP consultations (even prior to Covid-19), and admissions are growing at around 13% annually.

This new guidance would allow GPs conducting online consultations to refer patients with suspected pneumonia directly to an ARI hub for a face-to-face assessment, freeing up hospital beds for patients who need them.

Respiratory patients will require an in-person assessment to determine where they can best be cared for

During the appointment, a clinical assessment will be carried out using what is known as the ‘CRB65 score’, which uses several factors including the person’s age, blood pressure and respiratory rate to help the clinician make a judgement about managing the person’s pneumonia.

This assessment helps the clinician to determine whether the patient can be safely managed at home or in the community, or whether they will require an in-hospital assessment or treatment, reducing unnecessary admissions.

The guidance also recommends that clinicians:

• Should use a clinical assessment (rather than a microbiological or influenza tests) to determine whether to prescribe antibiotics for patients with symptoms of an ARI
• Consider a C-reactive protein (CRP) test – that can indicate the presence of infection – to help them decide whether to prescribe antibiotics to people without suspected pneumonia.

A “real game-changer”

Professor Sir Stephen Powis, NHS national medical director, said the new draft guidance will help “inform decisions on where a patient would be best treated while expanding the types of tests and other investigations used to determine the most appropriate treatment”.

Prof Powis says this will be “a real game-changer” that will give clinicians more options to care for patients in the community.

“This guidance will be hugely welcomed by local NHS teams, enhancing their ability to deliver the best possible care for patients, including in our innovative acute respiratory infection hubs and virtual wards – improving access to face-to-face appointments and helping prevent unnecessary hospital admissions for patients,” she added.