This FAQ has been developed following the first webinar in the ECRP webinar series and will continue to grow as the webinars take place and the programme develops.
Questions about the programme
Questions about the chronic cough workstream
Questions on the CLEAR Programme
Questions about the breathlessness workstream
Questions about the sleep pathway
Questions about the programme
What is the purpose of this programme?
The Elective Care Respiratory Pathways programme aims to improve Referral to Treatment (RTT) times and reduce variation and inequity in elective respiratory care. It focuses on the implementation and scaling of best-practice pathways (sleep, breathlessness and cough) in elective respiratory care across participating NHS providers.
Who is leading the programme?
The programme is supported by NHS England (NHSE) and delivered in partnership with the Health Innovation Network (HIN) and clinical champions. Each pathway or workstream is supported by a designated HIN and clinical champions:
• Sleep Pathway: Health Innovation Oxford & Thames Valley – Dr Allie Hare and Gavin Phillips.
• Breathlessness Pathway: Health Innovation Yorkshire & Humber – Dr Helen Ward
• Chronic Cough Pathway: Imperial College Health Partners – Dr Sean Parker and Mrs Claire Slinger
What are the workstreams?
- Implementation of Optimal Sleep Pathway
- Scaling breathlessness pathways in primary and secondary care
- Optimising chronic cough management across the patient pathway
Can you participate in more than one workstream?
Yes. NHS providers may participate in one or more workstreams.
How to apply?
If you are interested in participating in any of the workstreams, please complete the Elective Care Respiratory Programme Engagement Form.
Who can apply?
Applications are open to all NHS providers in England.
What resource is required?
This is a complex question, as the required resources will vary depending on how closely local pathway currently aligns with the “best practice” pathway(s) and the overall size of the service.
What is the implementation and delivery approach?
Each pathway is supported by a clinical champion and a designated health innovation network. Implementation support will be delivered through Action Learning Sets, providing a structured forum for continuous improvement, peer-to-peer problem solving, and consistent pathway delivery. Action Learning Sets allow rapid testing of adjustments, integration of best practices, and collaborative learning, driving sustainable and effective implementation. The learning, resources and outputs being developed through the Action Learning Sets have been captured within the Implementation Toolkit and supporting resources, making them available for all NHS Trusts and interested stakeholders to access, download and adopt to support local implementation.
What is expected from participating providers?
Providers are required to demonstrate:
- Capacity, willingness, and ability to engage in the programme
- Collaboration with relevant provider partners, including primary, community, and diagnostic services
- Commitment to sharing learning and implementing pathway improvements
Is funding available?
There is no direct funding for participation, however benefits of participation include:
- Access to clinical expertise and implementation support from designated clinical champions, HIN teams and NHSE.
- Adoption of best-practice pathways to support RTT reduction and service improvement
- Opportunities for shared learning and capacity optimisation
Are the sleep, breathlessness and cough pathways inclusive of all ages?
All workstream are for adults.
- Breathlessness: The pathway follows the NHS England Adult Breathlessness Pathway (Pre-diagnosis): Diagnostic Pathway Support Tool and is intended for adults presenting with chronic (more than eight weeks) persistent breathlessness.
- Chronic Cough: The pathway is based on the British Thoracic Society (BTS) Quality Statement for Chronic Cough in Adults and is therefore designed for adult services.
- Sleep: The Optimal Sleep Pathway has been developed for adult sleep services. However, many of the examples of best practice, business case development and workforce transformation may also be applicable across other services.
Will the presentation slides and webinar recording from the webinar series be shared?
Yes. The presentation slides and webinar recording will be shared with all attendees following the session. They will also be made available on the Health Innovation Oxford & Thames Valley website alongside the programme resources.
With ERS referrals moving to a national digital approach shortly, how are you managing bespoke referral pathways/forms within this model?
For the breathlessness diagnostic pathway, you can find the specific pathway form within ERS.
The cough workstream is looking at defining the core referral requirements and pathway principles that can be adapted locally as the national digital eRS approach is implemented, while recognising that some local adaptation will be needed to reflect individual Trust workflows and service configurations.
Breathlessness workstream
Is this largely happening at secondary care level?
While the programme initially focused on secondary care, it has since expanded into primary care through the neighbourhood extension workstream, supporting more integrated respiratory pathways across the system.
The Breathlessness Toolkit sounds very useful. How can I access a copy?
Each of the three workstreams is developing an implementation toolkit: a practical, step-by-step guide to support NHS service providers in designing, implementing, and improving local pathways. These guides, which include a range of case studies showcasing good practice, and all other programme resources are available on the Health Innovation Oxford & Thames Valley website.
Chronic cough workstream
How did they get GP education and buy -in?
GP’s were very much part of British Thoracic Society (BTS) guidance writing, ensuring that primary care is a fundamental part of the foundation of these cough pathways. There has been ongoing consultation with primary care/Primary Care Respiratory Society (PCRS) etc. In addition, there is a separate thread of work formulating advice and guidance materials to support referral processes.
The CLEAR Programme
Was the neighbourhood model tested with secondary care? Some PCN’s have to work with two Provider trusts?
Yes, secondary care were part of our design board initially and have supported the focused work with neighbourhoods to look at what it would take to implement locally.
Sleep pathway
Is there anything in the toolkit Management section about non-CPAP therapy?
There are still significant challenges nationally around access to mandibular advancement device (MADs). We continue to work on this and the toolkit will be updated with exemplars and guidance on access as this evolves.
Is there a place for some obstructive sleep apnoea (OSA) case finding, given the availability of data e.g. people with BMI >35 and 3 antihypertensive meds?
Yes. Suggestions on this are included in the Optimal Sleep Pathway.
For the use of WatchPat, is that outsourced or delivered in house? How did you reduce the analysis time so greatly if it was in house?
Both models exist and can also be developed with other home diagnostic devices.
A case study from Liverpool University Hospitals NHS Foundation Trust demonstrated significant improvements:
- Traditional polysomnography had a failure rate of approximately 29%, often requiring repeat studies and extensive analysis.
- WatchPAT reduced the failure rate to approximately 0.1% across more than 11,000 studies.
- The improved quality of recordings reduced average reporting time from approximately 60 minutes to 20 minutes per study while maintaining a detailed clinical report.
This case study is included within the Optimal Sleep Pathway toolkit. There are other novel approaches with different diagnostic devices and pathways that will also be included within the toolkit.
Will additional diagnostic approaches be included in future versions of the toolkit?
Yes. The toolkit will continue to evolve and will include additional examples of innovative diagnostic devices, service models and pathway improvements as further evidence and case studies become available.