1.  OBJECTIVES OF NADAAS

Recognition of the allergy patient/sufferer. Provision of allergy diagnostic assessment/skin prick testing.

Provision of patient empowerment to manage and understand their allergic condition.

To improve quality of life of the allergic patient/sufferer.

To provide education and allergy awareness to fellow professionals in primary care.

2.  OVERVIEW OF THE SERVICE

  NADAAS was initially set up as a private service in 1986-87, following a submission of a paper on NADAAS cost effectiveness(1) in terms of health management and financial savings to the NHS, NADAAS was awarded a contract by the then Norfolk FHSA on a self-employed basis. The funding is on a cost per case basis, which includes the costs of running the service, travel, administrative help, (provided by my husband) and salary.

  Patients are referred by their GP, hospital consultant or doctor.

  The patients are seen for allergy assessment at their GP surgery or another designated local surgery. (The latter in order to cut waiting list time). Patients are offered a choice of venue and appointment time. Currently funding is provided by four PCT's and administered quarterly by one PCT on behalf of al1 four.

  Administration of NADAAS is carried out from the providers' home office, where the referrals are received.

  Following an holistic assessment of all the patient's symptoms, skin testing and advice on management, a full report is given to the patient, GP, Hospital consultant or Doctor. The consultation takes one to two hours and is a one-stop shop, in addition NADAAS offers a patient phone-in service between 6-7 pm Monday to Wednesday" evenings.

  Clinic waiting list can be six to 12 weeks (depending on holiday leave etc).

  NADAAS receives approximately 400 NHS referrals per year, funding allows for 300 patients per year, which is allocated on a cost per case basis. (32,900 per annum).

  Appointments are initially arranged by phone then followed up by written confirmation.

3.  OUTCOMES/BENEFITS OF NADAAS

  NADAAS meets the requirements set out in the European White Paper (Brussels), Allergic Diseases as a Public Health Problem 1997,(2) which states "that the majority of allergy care can and should be managed in primary care". And the criteria stated in Containing the Allergy Epidemic the unmet need" from the Royal College of Physicians, 2003,(3) "Primary care must ultimately provide the front line care for allergy".

  NADAAS has been able to demonstrate(1) in those patients found to be allergic over a period of 18 months post allergy assessment:

A reduction in prescription rates of 59%.

A reduction in repeated doctor consultation of 70%.

An improvement in well being of 70%.

  NADAAS is able to demonstrate that 3% of patients assessed required review appointments and less than 3% required referring on to an organ based consultant with an interest in allergy or to the Regional Allergy specialist.

  The overall cost of the service is cheaper than that offered by a hospital consultant/doctor.

  The service is valued by the GP's, currently NADAAS has 120 surgeries on its books and a recent survey has shown that over the past five years 30 doctors from the local hospital have used the service. These include doctors from Respiratory, ENT, Pediatrics, Gastroenterology and Dermatology departments.

  NADAAS is valued by the patients, they are (particularly children) appreciative of being able to be seen at their familiar surgery. Generally on arrival they are seen promptly but rarely more than five minutes later than the given appointment. Patients value not having long journeys to local or district hospitals, thus reducing the amount of time lost from school or work. There are no parking problems and no parking costs. They value the quiet one to one, one-stop allergy assessment.

  NADAAS is recognised nationally and internationally.

  In 1998-99 two representatives from the Department of Health, a Nurse advisor and an administrator spent a day in the NADDAAS clinic. They assessed the service to be a model of excellence, which should be emulated across primary care.

4.  THE PROVIDER

  She has presented papers nationally and internationally, written numerous articles on allergy and published a book on Skin Prick Testing in Clinical Practice. She has received travel scholarships and national awards for her unique work in allergy. She has been involved in professional education. development and implementation of education programmes.

  She is Co-Founder member, past Trustee and current Vice-President of Allergy UK.

5.  PLANNED DEMISE OF NADAAS

  Reasons given for the cut in the service:

(a)  Allergy is not a high priority in HA budget.

(b)  Service is only patchily used.

(c)  Allergy can now be managed in the local Dermatology Department and the Regional Hospital in Cambridge.

  Some Doctors using and valuing NADAAS have written to advise that they were never consulted about the cessation of the primary care allergy service, despite published reports to the contrary.

6.  RECOMENDATION

  (a)  It would be helpful if HA were to offer local education programmes for primary care workers in order to recognise the potential allergic patient, though it is apparent that those doctors who do not use NADAAS are less likely to attend allergy education programmes.

  (b)  Allergy management should be based on a pyramid plan with Primary care identifying the allergic patient, referring them (up the pyramid) on to local doctor/nurse with an interest or specialist skills in allergy who would then be able to identify the more complex allergic cases for referral to the regional allergist, (top of pyramid). This will reduce long-waiting lists at regional hospitals, and afford early education of the patient and carers on the management of their allergy.

REFERENCES

  (1)  Brydon M J, The effectiveness of a peripatetic allergy nurse practitioner service in managing atopic allergy in general practice—a pilot study. Clinical and Experimental Allergy, 1993, Vol 23, pages 1037-1044.

  (2)  Van Moerbeke D et al, European Allergy Paper, Allergic Diseases as a Public Health Problem. May 1997. UCB Institute of Allergy, Brussels. ISBN: 2-87301-018-5.

  (3)  Royal College of Physicians, Containing The Allergy Epidemic. June 2003. Summary and recommendations of a new report from the RCP Allergy—the unmet need: a blueprint for better patient care.

May 2004