GPs in several areas of England are not being paid to offer common tests to diagnose conditions like asthma and chronic obstructive pulmonary disease (COPD), an investigation has found.
Experts said that the data shows that many ICBs are still not prioritising spirometry tests in primary care, with some reducing funding or not ringfencing funds for testing.
The data shows a ‘lottery’ of availability of the LES in England, with 11 of the 42 ICBs (26%) not offering GPs the spirometry LES in 2025/26 (see also box below).
The budget figures, which our sister title Pulse obtained from ICBs from Freedom of Information (FOI) requests, also show seven of the ICBs offering the LES to GPs did not increase their spirometry budgets, of which five ICBs reduced their budgets.
A total of 30 ICBs said they offered a spirometry LES in parts or all of their patches – 22 of which provided clear budget data. Sussex, Buckinghamshire, Oxfordshire and Berkshire West, Frimley, Shropshire, Telford and Wrekin, and Coventry and Warwickshire all reduced their budgets.
Meanwhile, Derby and Derbyshire and Bath and North East Somerset, Swindon and Wiltshire ICBs maintained the same budget from 2024/25.
This variation is also evident in how much GPs are paid to perform this enhanced service, and which costs ICBs factor into their payments.
Just one in three ICBs providing budget information referenced payments for training or equipment costs associated with providing the LES.
Documents for the spirometry LES obtained by Pulse also show that some ICBs put clauses in that would allow them to claw back payments, cap funding per patient, and don’t pay practices if patients don’t attend.
Dr Paul Evans, a GP and LMC lead in Gateshead, said that underfunding of these services was an issue, and that caps on tests specifically were unhelpful. He said: ‘There will be some cases where the spirometry tests are done and are inconclusive, or the patient needs a second go, because maybe the first test has been done when they’ve been rather unwell, and it doesn’t draw any definite conclusions about whether someone has asthma or COPD from that test.’
Professor Azeem Majeed, a GP and head of the Department of Primary Care and Public Health at Imperial College London said: ‘The investigation highlights the persistent postcode lottery in respiratory diagnostic services across England, which will have a direct impact on both general practices and patients.
‘From a practice perspective, the absence or underfunding of a spirometry LES places additional pressure on already stretched primary care teams.
‘Many practices will either have to absorb the cost themselves (which is increasingly difficult given the financial challenges facing general practice), refer more patients to secondary care respiratory clinics (adding to hospital waiting lists) or delay testing. This undermines the ability of GPs to diagnose and manage common respiratory conditions such as COPD in the community.’
Specialist medical accountant Andy Pow, who is an adviser to the Association of Independent Specialist Medical Accountants (AISMA), said that spirometry was an example of a LES which should be offered universally and where variations in payments to GPs did not make sense.
Mr Pow said: ‘For things like spirometry, the price being paid varies massively across the country, but everyone wants the same service, I feel there has to be a national tariff for these things that makes it fair and gives clarity on what people are paying for.
‘You’d have thought some services are fairly universal in what’s required, and perhaps it just got over complicated because we’ve localised everything.’
Asthma + Lung UK’s head of policy and public affairs Jonathan Blades said: ‘This data shows that too many ICBs are still not prioritising spirometry tests in primary care, with some reducing funding or not ringfencing funds for testing. This is not acceptable.
‘These stark disparities show why the Government must commit to providing local healthcare services, particularly those in areas of high deprivation, with sufficient funding to ensure everyone can access respiratory tests.
‘Alongside the respiratory sector, we’re calling for the Government to commit to a Modern Service Framework for respiratory care to improve spirometry access across the country and improve timely and accurate diagnosis.’
An NHS England spokesperson said: ‘We recognise the importance of early and accurate diagnosis of respiratory disease through quality-assured spirometry.
‘In many areas, spirometry is provided in Community Diagnostic Centres – which are being expanded to more areas of the country as part of a £237m government investment – whereas some ICBs choose to commission this as an enhanced service from GPs.’
Meanwhile, the results of a survey run by Management in Practice and Pulse has indicated there is concern over LES underfunding in general practice, which is threatening provision. More than four in 10 GPs (of 225 who responded) said that their ICB ‘significantly underfunds’ LESs for general practice. Adding respondents who said their commissioner ‘slightly’ underfunded LESs, this figure rose to nearly three-quarters (74%).
And 65% of 189 practice manager respondents said LESs were either ‘significantly’ or ‘slightly’ underfunded.
One practice manager commented that their ICB ‘significantly underfunds practices for local enhanced services’ but the variability is within their patch so ‘our area gets half what our neighbours do.’
Another who said their ICB also significantly underfunds practices for local enhanced services
explained that: ‘Some of the calculations for payment do not account for the actual time taken to fulfil all the criteria. Some of the targets set us up to fail from the beginning as we cannot always achieve it either through lack of demand or because it so high, so funding is clawed back from us.’
ICBs not offering spirometry LES to GPs (ICB boundaries are the ones pre 1 April, 2026)
- Birmingham and Solihull
- Devon
- Dorset
- Leicester, Leicestershire and Rutland
- Mid and South Essex
- North Central London
- Northamptonshire
- Somerset
- South East London
- South Yorkshire
- Suffolk and North East Essex
Source: Pulse
Spirometry budgets that did not increase
Source: Pulse
| ICB (boundaries are those pre 1 April 2026) | 24/25 Budget | 25/26 Budget | % change |
|---|---|---|---|
| Coventry and Warwickshire ICB | £252,160.00 | £57,110.00 | −77 |
| Buckinghamshire, Oxfordshire and Berkshire West ICB | £1,198,000.00 | £634,644.00 | −47 |
| Shropshire, Telford and Wrekin ICB | £144,506.75 | £113,819.00 | −21 |
| Frimley ICB | £288,504.00 | £263,812.00 | −9 |
| Sussex ICB | £691,685.00 | £684,317.00 | −1 |
| Derby and Derbyshire ICB | £336,000.00 | £336,000.00 | 0 |
| Bath and North East Somerset, Swindon and Wiltshire ICB | £69,325.00 | £69,325.00 | 0 |
A version of this article was first published by our sister title Pulse
