Service evaluation of a UK primary care-based allergy clinic: quality improvement report

Allergic diseases are common, increasing, and associated with significant morbidity and occasional, but potentially avoidable, mortality. There is widespread public, professional and government agreement about the poor quality of care received by many patients with allergic diseases in the UK. Many remain undiagnosed, few have access to specialist services, and the majority of primary care health professionals have no allergy training. We report an evaluation of a novel, UK NHS-funded primary care-based allergy service in North West London.

The clinic was run by a specialist allergy nurse and a general practitioner (GP) with a special interest in respiratory disease and allergy. Referrals from local GPs were made on dedicated proformas and handled according to developed and agreed community care pathways.

141/151 (93%) of those referred attended the clinic. On average, patients waited 15.7 (SD 15.67) days from referral to an offer of an appointment and were seen 18.11 (SD18.07) days from the date of referral. The majority of patients were referred for hives or wheals (61;40%), suspected food allergy (28;40%), multiple reasons, (19;12%) or rhinitis (19;12%). Skin prick and specific-IgE tests were performed on 69 (49%) and 19 (14%) patients respectively, with 4 (0.3%) patients having both. We estimated an overall saving of at least pound13,580 to the local health economy - through reduced secondary care referrals - during the nine months' duration of the clinic. Assessed using a validated patient satisfaction questionnaire, most patients rated their satisfaction with the service with an overall median score of 75% (IQR 65.64-82.32).

A primary care allergy service provided by appropriately trained personnel can cater adequately for the majority of primary care referrals. This model provides a pathway of care that supports self-directed care, reduces inappropriate referrals, and encourages care in the local community. The model is one that could easily be developed further into a clinical assessment service for allergy including respiratory based (asthma) problems. This would expand the scope and ensure value for money as well as responding to a clinical need with significant incidence locally. The UK Department of Health should consider rolling out this primary care-based model nationally.