Building evidence on the benefits of testing and treating in the community

Health Innovation North West Coast has just published our case study and full report, including a mixed method evaluation, on a test and treat community pathway for acute respiratory infections (ARI).  

Our team was grateful to work in close partnership with regional clinicians to co-design this pathway during the 2023/24 winter season. Everyone involved felt it was important to build on existing evidence of the significant potential benefits of community point-of-care testing, particularly during flu season, which can cause significant strain on our health system.  

The benefits could include reducing the prescription of unnecessary antibiotics, reducing pressure on A&E departments and secondary care, and, most importantly, preventing severe illness and death in the most vulnerable patients. 

As well as building evidence, we believe this report has captured some valuable insights from primary care staff, point of care leads and patients. They welcomed the testing and were enthusiastic for change. Clinicians had a number of concerns, but we also captured lots of practical suggestions and recommendations to improve the pathway. 

Patients felt reassured that a more accurate diagnosis would provide them with better treatment for their symptoms. They also appreciated the convenience of testing done onsite at their local practice. 

Primary care staff and point of care leads also welcomed testing but had more concerns with implementation. This brought up issues of the types of tests used, where testing would be done, staff training, and the need for central co-ordination, IT integration, funding and governance.  

Interestingly, primary care staff brought up the fact that community testing would reduce pressure on A&E and secondary care, but that the primary care workload would increase. Funding would have to be factored in.   

Similar altruistic benefits lie in antimicrobial stewardship and pandemic preparedness, where benefits are not immediately felt at the primary care level, but are nevertheless very important to the future of the whole health system.  

Without diagnostic decision support, GPs tend to err on the side of caution. The first line of action for clinicians is ‘if in doubt, and the patient is vulnerable, prescribe antibiotics’. Therefore, diagnostic certainty would have a huge impact on antimicrobial stewardship. However, clinicians agreed that this would only be effective if test results were timely enough.   

With any significant process change, community test and treat will require centralised co-ordination, and relevant system stakeholders need to be involved to ensure a sustainable system-wide change. 

Fortunately, conversations are already taking place at all levels around enabling these pathways. Our team plans to share our findings with policy and commissioning colleagues and suitable publications. We also plan to work with the NW’s point-of-care network to expand to a full feasibility study during winter 2024/25. 

Overall, clinicians felt optimistic that community test and treat will be the norm soon. Our team is equally optimistic! 

We would like to thank Moreton and Meols Primary Care Network, Marine Lake Medical Practice, Wirral Teaching Hospital NHS Foundation Trust and Liverpool University Hospitals NHS Foundation Trust for collaborating with us on this report. Thanks also to Cepheid, a healthcare diagnostics innovator, who made this report possible through funding. 

Read more:  

• summary case study
• full report
• previous work from 2022/23, which helped informed this year’s report. 

Omobolanle.Olagunju@healthinnovationnwc.nhs.uk