Fractional exhaled nitric oxide testing in Primary Care settings: FOI release

Information requested

1. What assessment the government has made of the current availability of FeNO testing in primary care settings in Scotland;

2. What lessons from the experience in England may be applicable in Scotland to increase the availability of FeNO testing;

3. Whether central funding may be required to support primary care services to meet the cost of FeNO testing, the savings from which are typically accrued elsewhere in the health system;

4. What other steps the government is considering to support greater adoption?

Response

1. What assessment the government has made of the current availability of FeNO testing in primary care settings in Scotland

In November 2024, a new collaborative asthma guideline developed jointly by the British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) was published: Overview | Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) | Guidance | NICE . Fractional exhaled Nitric Oxide (FeNO) testing is recommended as one of the objective tests to support an asthma diagnosis when clinical history suggests asthma, it also acknowledges that FeNO testing may not be available in all clinical settings.

Although a key recommendation in clinical guidelines, FeNO testing is not mandatory and is one of several diagnostic tools in asthma diagnosis. Currently in Scotland, FeNO testing is not available in all primary care settings but is available in a mixture of settings including secondary and community care. Service delivery is defined by Health Boards prioritising services to best suit local need. When treating and diagnosing asthma, clinicians will make decisions appropriate to the individual circumstances of each patient.

2. What lessons from the experience in England may be applicable in Scotland to increase the availability of FeNO testing;

NHS England ran a national FeNO programme up to March 2023 as part of its Rapid Uptake Products programme, this examined improving access to FeNO testing in primary care, the results of which was used to inform the BTS, NICE and SIGN guideline.

We have been working with stakeholders in NHS England to understand how they are increasing access to FeNO testing and will continue to liaise with them to understand what lessons can be learned and where appropriate adapted to work for our NHS in Scotland.

3. Whether central funding may be required to support primary care services to meet the cost of FeNO testing, the savings from which are typically accrued elsewhere in the health system;

In 2025/26 we are providing £21.7 billion to our NHS with £2.2 billion of this for primary care. We know most people with asthma are treated by their GP or Practice Nurse and we have committed to a greater proportion of new NHS funding to primary and community care so that GPs and services in the community will have the resources they need for their essential role in diagnosing and managing conditions like asthma. However, we know that FeNO testing is also used in secondary and community care settings. As such, it is for Health Boards to distribute funding in the way that best supports local delivery in their area.

4. What other steps the government is considering to support greater adoption.

We expect all clinicians to adhere to and consider all relevant clinical guidelines when assessing someone who is presenting symptoms of any condition, this includes the new asthma guidelines published by the British Thoracic Society, NICE and SIGN. We know that adopting new guidelines to existing services can take time and we will work with key stakeholders across health and social care to ensure the guidelines are adopted appropriately across Scotland.

We will continue to collaborate with and support the Centre for Sustainable Delivery (CfSD). Through their Respiratory Speciality Delivery Group there is a significant programme of work regarding respiratory improvement, this includes national pathways for severe asthma, COPD, sleep apnoea and interstitial lung disease. All relevant clinical guidelines and their recommendations are considered when developing these pathways, this includes the newly published asthma guidelines by the BTS, NICE and SIGN published in November last year.

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