Improving patient outcomes and boosting antimicrobial stewardship by testing and treating for acute respiratory infections in the community

Health Innovation North West Coast has led a multi-year study to optimise the point-of-care (POC) testing for acute respiratory infections in the community.  

For the third flu season (2024/25), we have continued to generate evidence demonstrating the value of this approach – preventing severe illness, easing pressure on urgent/emergency care, avoiding hospitalisations (including ICU admissions) and deaths, and increasing antimicrobial stewardship.   

Continuing testing on the Wirral  

This season, Moreton Group Practice in Wirral asked to continue the pilot testing we helped them set up on site in 2023/24. They were able to keep the POC testing machine provided by Cephid from the previous season, and Cephid provided free swabs and cartridges materials to them.  

The practice’s aim is to diagnose and treat patients more effectively so they don’t develop a chest infection. This year the practice further refined their processes, creating flow charts and electronic forms, determining the best place to upload forms and store testing materials. 

Dave, a paramedic at the practice, runs the tests and uploads the results. He finds the machine very easy to use, fast with results in 36 minutes, and builds testing into his other work. Their goal is to run the sample either the same day or within 24 hours.  

In the 2024/25 year, they had a steady flow of samples, more positive results and a range of results, including flu A and B, RSV, Covid and combinations of more than one.  

Dave said: “Clinicians like it because we like to know what we are dealing with and we can make a plan with the patient. We can target the cause straight away instead of trying a number of things.” 

The work is designed to be testing agnostic, where the specific types of tests and testing machines is secondary to creating successful pathways. Over the three seasons, teams have tried several POC machines.  

Joining up efforts across the North West 

Additionally during this flu season, we continued to work with the North West POC leadership group, to share our learning, tools and resources, and encourage others to join up data to strengthen the evidence behind POC testing for acute respiratory infections (ARIs) in the community.  This group includes pathology and primary care leads from Cheshire and Merseyside, Greater Manchester and Lancashire and South Cumbria. 

Mandy Townsend, Associate Director of Patient Safety at Health Innovation North West Coast, said: “This novel approach will require a pathway change, which needs system-level support and Health Innovation North West Coast is able to facilitate these conversations.” She said that the cost for the testing will sit in primary care and pathology, but that the benefits are realised in secondary care, and beyond when the antimicrobial stewardship benefits are accounted for. 

Helen Liggett, North West Regional Science Lead for NHS England, said: “We need to demonstrate the impact of POC testing for ARIs in the community at a greater scale, and harmonise our data in the North West. If integrated into care pathways, this approach could meet government priorities, improve patient care and achieve significant cost savings. And, if replicated across the UK, this could have significant implications for antimicrobial stewardship.”   

Next steps 

Mandy said: “Our long-term goal is for UK-wide spread and adoption.” 

Health Innovation North West Coast is in the advanced stages of agreeing two years of more testing pilots for the 2025/26 and 2026/27 seasons with North West partners. This involves a full feasibility study with the NW POC Network and 6-8 “CARI hubs” in Cheshire and Merseyside and Lancashire and South Cumbria. We will continue to work closely with Greater Manchester and are sharing our learning across the North.