The NHS Accelerated Access Collaborative (AAC)

Thursday, December 2, 2021

We met Dr Hitasha Rupani who works at University Southampton NHS Foundation Trust, to talk about her involvement with the NHS Accelerated Access Collaborative (AAC). Hitasha is a respiratory consultant, with a special interest in asthma.

Welcome Hitasha. Please can you start by explaining a little more about the AAC?

This is a really interesting initiative to be part of. The AAC is supporting the uptake of treatments that have a strong evidence-base and support Long Term Plan priorities, yet are used less often than would be expected.

What are the aims of the AAC?

Back in 2016, the Accelerated Access Review found that it took over ten years for innovations to make it into the NHS. The AAC was formed in response to this, bringing together the full range of stakeholders from across the health system to work in partnership to ensure that patients receive the best innovations.

The AAC is hosted by NHS England and Improvement and aims to get more proven innovations into the hands of clinicians and patients, faster.

This year we have been very fortunate because the AAC have selected 2 asthma-themed ‘products’ for its rapid uptake product programme:

  1. FeNO for the diagnosis and management of asthma
  2. Asthma biologics for treating severe asthma: omalizumab, mepolizumab, reslizumab and benralizumab

Who is involved in the AAC?

The AAC is hosted by NHS England & Improvement but covers a broad consortium of partners supporting asthma care. This includes our key delivery partners- the AHSN Network, NICE, Asthma UK, Primary Care Respiratory Society (PCRS), Association for Respiratory Technology and Psychology (ARTP), Association of Respiratory Nurse Specialists (ARNS), Patients, Industry and of course BTS.

Each asthma programme has a working group to help drive the projects and includes patient representatives and key product partners - so for the FeNO AAC programme, there are representatives from Bedfont and Circassia, while for the asthma biologics programme, there are representatives from the biologics providers - GSK, AZ, Teva and Novartis.   

Could you outline the progress with FeNO?

The use of Fractional exhaled Nitric Oxide testing, or FeNO testing, is included in the NICE clinical guidance for asthma diagnosis (NG80). FeNO testing is commonly used in hospitals but the use of FeNO testing in primary care, where most of the asthma diagnoses takes place, is scarce and patchy.  

There is an opportunity for the FeNO programme to support improvements to asthma diagnosis and outcomes by improving access to FeNO testing in primary care.

The programme has four priority areas:

  • Training and education
  • Collecting best practice to highlight the models of delivery that yield the best outcomes for patients
  • Working with commissioners to identify the most appropriate funding models
  • Developing a roll out toolkit to support the implementation of FeNO testing at scale and sustainably

The AHSN Network are supporting implementation across England. You can find your local AHSN and their contact details online.

What are the key outcomes so far?

Implementation toolkit and dashboard – to support implementation and sustainable use of FeNO testing, the team has developed an extensive online FeNO implementation toolkit – comprising details on the supported products, clinical information (e.g. pathways, case studies, case finding resources and infection control) and implementation materials (e.g. business cases, project plans, action learning sets etc.)

Specifically, the FeNO programme has developed a national FeNO learning collaborative to bring together people using FeNO, implementing FeNO, and contemplating FeNO use. You can find out how to join the next collaborative online.

The programme has also developed an Ardens data collection template – available for all EMIS and TPP SystmOne users free of charge – to support the collection of FeNO test information.

The Ardens template and the wider FeNO tool can be accessed at this link.

Education – working with the Heath Education England (HEE) Technology and Enhanced Learning (TEL) team, the FeNO programme has developed two FeNO training modules, principally targeted at a primary care audience. They aim to enhance awareness of FeNO testing in primary care to support increasing uptake whilst also ensuring HCPs are provided with the knowledge and skills required for the optimal use of this technology in the diagnosis and management of asthma.

The first FeNO in Asthma educational module is available through the Health Education England e-Learning for Health portal – it should take around 30 minutes to complete.

A provision date of the 14th December is set for the release of the second module.

Are there any resources for patients?

The AAC has been working with BLF/Asthma UK and a patient information leaflet and accompanying video describing what FeNO testing is are now available – both are available on the FeNO toolkit.

You can contact any of the core working group team for more information (see end of feature)

Moving to the work on biologics, can you outline the key activities in this area?

The key priority areas are:

  • Understanding the current context
  • Early identification
  • Training and education
  • Reducing variation and improving pathways

What do you see as the most significant progress so far?

Understanding current practice

  • A scoping report has been drafted to capture the key issues that currently impede adoption of asthma biologics
  • A national benchmarking exercise has helped capture insights around variations in pathways and practices
  • We have carried out a review of a patient’s journey from referral to a severe asthma centre to initiation of a biologic to help identify the time spent at each stage of the patient journey

Early Identification: Identifying uncontrolled asthma

A primary care risk stratification tool (SPECTRA) has been launched and is now being piloted to help to identify patients who may be at risk of severe asthma.

As part of this tool we have also developed a referral template that auto-populates from primary care records to facilitate referral of patients to secondary and tertiary care while ensuring all the relevant information is captured. A clinical training package to support this has also been developed.

Early Identification: Patient resources

Resources for patients are also available which provide information to patients at the early stages of the pathway.

Asthma Biologics Toolkit

A toolkit has been developed by Oxford AHSN to bring all the relevant resources (including best practice case studies) together into one place. 

What are the next steps?

The key activities moving forward will include:

  • The development of a consensus pathway for uncontrolled asthma which will include clear guidance on referral steps and wait times
  • The development of a training and resource deck with Cogora to be launched Dec 2021
  • Local improvement activity led by the AHSN network ongoing.
  • A webinar was held on SPECTRA (patient identification tool) 18th Jan 2022.

UPDATE March 2022 - The AAC will launch their ‘Consensus Pathway for the Management of Uncontrolled Asthma’ at a free webinar at 7pm on Wednesday 23 March. To attend the webinar, please visit https://www.tfaforms.com/4959771