GP Sleep Study: Dr. Ian Smith

The sleep service at Royal Papworth Hospital (RPH), led by Dr Ian Smith, provides all diagnostic services for the CCG of Cambridge and Peterborough and complex sleep diagnostics regionally for East Anglia. In 2017 -18 we had in excess of 2700 referrals with a query of OSA and 1638 patients were initiated on CPAP therapy. Much of our catchment area is rural with only modest urban concentrations meaning that most patients face considerable journey times.

In order to improve access to diagnostics we have worked with GP’s and the CCG to develop a network for community screening for OSA. Dispersed through the CCG (the second largest in the England) there are 13 GP practices which host oximeters (of a suitable diagnostic standard) provided from, and maintained by, RPH. Surrounding practices refer patients in to these hubs. Patients complete a questionnaire and overnight oximetry and the data are sent to RPH for analysis.

Around 35% of patients, with minor symptoms and normal oximetry, are reassured and never need to travel to RPH. Around 45% of patients have moderate to severe OSA and are brought to the centre to initiate CPAP therapy. Patients with troublesome symptoms and borderline oximetry (around 20%) have more complex monitoring with respiratory polygraphy, and approximately half are ‘upgraded’ to OSA of at least moderate severity. Since the service is delivered in the community, it is outside the usual tariff system and represents a saving to the CCG, which amounts to more than £100k per annum. We are on track to see >750 patients through this limb of our service in 2018.

The community screening service has proved very popular with GPs and patients and now accounts for nearly a third of our diagnostic tests for new patients. The NHS publishes median waiting times for 15 categories of diagnostics including, for example, endoscopies and radiological tests. In the 6 months from August 2017 to January 2018 sleep studies had the longest wait of all 15 categories. The incidence of OSA is increasing due to increased longevity and obesity.

In the UK the proportion of the population recorded as obese has risen from 15% in 1993 to 27% in 2015. In order to manage the continually growing demand for resources our service may be a viable model for other regions in the UK.