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Case study: Integrated approach transforms lives of more people with severe asthma


A pioneering initiative is transforming the lives of more people with severe asthma who were missing out on life-changing medication. The Integrated Severe Asthma Care (ISAC) project across Buckinghamshire, Oxfordshire and Berkshire West found hundreds of patients who could potentially benefit from innovative biologic therapies. This was achieved by proactively identifying patients with uncontrolled asthma through a detailed search of primary care records. Specialist pharmacists then worked with multi-disciplinary teams to set up community clinics close to patients’ homes with a focus on areas of high deprivation where referral rates were particularly low. Detailed consultations utilising breath test machines helped to identify patients who would benefit from biologic therapies and put them on a fast track referral to the Oxford Severe Asthma Centre. The new community clinics also offered patients support around other medication and use of inhalers. There was positive feedback from both patients and clinicians.

The project received financial backing from the NHS Pathway Transformation Fund and was supported by the Oxford AHSN (now Health Innovation Oxford and Thames Valley) which led a two-year national programme to increase uptake of biologics for people with severe asthma across England. This medication transforms patients’ lives by reducing airway inflammation and helping to manage symptoms leading to fewer hospital admissions. It also reduces reliance on other medicines including oral steroids which have significant long-term side-effects.

What did we do?

The initiative worked with eight primary care networks and reviewed more than 2,000 patients registered at 26 GP practices. Of these, 241 people were identified as potentially benefitting from biologics and were invited to attend a new clinic.

What has been achieved?

  • The attendance rate at the clinics was 62% (149 patients).
  • 53 people were referred to the Severe Asthma Centre in Oxford.
  • 90 people started receiving biologic therapies.
  • 45 patients switched to a more environmentally friendly type of inhaler.
  • An estimated £390,000 was saved due to reduced need for acute hospital care (additional savings expected through fewer side-effects with reduced use of high dose steroids).

What people said

  • “I’ve had asthma for over 50 years, but this has been an incredible service. From speaking with the pharmacist to being seen in the hospital. Excellent service which has changed my life.” – Patient
  • “Patients told us that we have changed their lives by taking enough time to take their concerns into consideration.” – Ola Howell, specialist pharmacist and ISAC project co-lead
  • “We are proud that our small team continues to deliver this innovative and truly integrated service which continues changing lives and bringing clinicians from across the sector together.” – Andrew Chadwick, consultant in respiratory and intensive care medicine
  • “Ultimately getting earlier specialist and tertiary care reviews through the severe asthma team is highly beneficial for patients. Getting them asthma biologics medication will have a significant impact on improving their health outcomes and quality of life.” – Paul Swan, integrated respiratory delivery network manager, Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System
  • “We were thrilled to be part of this collaborative approach to really understand the key challenges in improving severe asthma care. The integrated approach adopted in Buckinghamshire, Oxfordshire and Berkshire West addressed some of the critical barriers to improving severe asthma care.” – Dr James Rose, Director of Strategic and Industry Partnerships, Health Innovation Oxford and Thames Valley

What next?

New patients are continuing to receive biologics beyond the end of the project and the multi-disciplinary teams have been sustained. Six more PCNs are taking part in the next phase bringing the total to 14 covering a total patient population of more than half a million people.

The teams are sharing best practice and lessons learned regionally and nationally in partnership with Health Innovation Oxford and Thames Valley. A national event for respiratory leaders focusing on the future of severe asthma care took place in London in July and the work was also featured at a Royal Society of Pharmacologists meeting. The project was a finalist in two national awards in 2023 – HSJ (Medicines, Pharmacy and Prescribing category) and Integrated Health (Impact category).

The potential to apply this model to other asthma services and other specialties which also rely on high quality referrals from primary and secondary care is being explored.

A further £100,000 has been secured via the NHS Innovation for Healthcare Inequalities Programme (InHIP) to continue the ISAC initiative. This is supporting evidence-based management and clinical optimisation of people with uncontrolled and severe asthma living in the most deprived areas. The ISAC team is continuing to proactively identify, review and refer patients to initiate biologic therapy.

There are still several hundred patients eligible for asthma biologics across Buckinghamshire, Oxfordshire and Berkshire West who are not yet receiving them.