Backlog of basic care could lead to "avalanche" of unscheduled care this winter

The UK’s leading respiratory charity is calling on NHS England to urgently outline how it plans to address the growing backlog of basic care, with winter being the deadliest season for people with lung conditions.

Every year annual winter pressures on the NHS are driven by a spike in respiratory hospital admissions. Plummeting temperatures, colds, flu and now Covid-19 can all cause symptoms to flare up and trigger potentially life-threatening exacerbations. There are 80% more lung disease admissions in the winter months of December, January and February then there are in the warmer spring months of March, April and May.*

Basic care for people with respiratory disease gets people in the best shape to deal with winter and stops people ending up in hospital. The charity is now calling on NHS England to increase support for primary care professionals including GPs and nurses in delivering the basic care respiratory patients need, to prevent an avalanche of unscheduled care and respiratory hospital admissions which could threaten to overwhelm the NHS.

With winter fast approaching, Asthma UK and the British Lung Foundation has created a roadmap to restore and improve basic care and calls on NHS England to: 

  • Ensure all GP practices have the digital tools they need to support video and telephone consultation as well as face-to-face consultations
  • Clearly communicate that patients can choose how they are seen based on their preferences and clinical need
  • Outline how primary care can identify, diagnose and treat people with new symptoms of respiratory illness this winter and also address the current backlog of diagnostic tests
  • Support primary care professionals to address the backlog of annual reviews for respiratory conditions by prioritising those most at risk

The government is calling on everyone to protect the NHS this winter by taking steps to look after themselves, but Asthma UK and the British Lung Foundation says this cannot happen if people with chronic lung diseases are not getting basic care, including monitoring, treatment and interventions to keep themselves well and out of hospital.

While some people with lung conditions have been able to access basic care throughout this turbulent time, it has not been consistent across the country. The pandemic has had a huge impact on people with lung disease, with many having experienced appointments being cancelled, annual reviews postponed, and face-to-face care suspended. Asthma UK and the British Lung Foundation estimates that up to 1.8 million people with lung conditions could have missed out on annual reviews during lockdown, essential for helping people stay on top of symptoms and ensuring they are on the correct medication.**

GP practices have had to make vast changes to the way they deliver care in order to protect staff and patients across the health care system from coronavirus. Challenges they have had to overcome include the shift to remote care at the height of the lockdown, the build-up of people waiting for specialist care referrals and addressing the backlog of basic care which patients have missed due to Covid-19.

Our recent survey of 8,000 people with lung disease found that 35% had their respiratory care delayed or cancelled during lockdown, and around a quarter of these had respiratory symptoms worsen due to care being delayed or because they avoided using the health service.***

Margaret Dempsey is 76 from Leicestershire and has asthma and bronchiectasis along with other serious chronic health issues including diabetes and a heart condition. She said:“I’ve tried to get a face-to-face appointment at my GP practice recently, but they can only offer one over the phone. I want to be seen by a GP because I have multiple health issues and feel without being seen things might get missed.

“This system isn’t working for me and if anything is making my health worse. Over the last couple of months my lungs have really been playing up and I’m wheezing, coughing and bringing up mucus everyday which is a real struggle. I already feel incredibly isolated and my experiences so far have completely put me off contacting the doctor for more support. It feels like there’s no point in trying.”

Alison Cook, Director of Policy and External Affairs at Asthma UK and the British Lung Foundation said: “Failure to prepare for the predictable seasonal spike in respiratory admissions, by ensuring people with lung disease are as well as possible, could threaten to overwhelm the NHS this winter.

“NHS England must urgently outline how it plans to support primary care professionals in restoring basic care, especially for those with respiratory conditions, to prevent an avalanche of unscheduled care and hospital admissions.

“It’s critical that people with lung conditions, who are at risk of becoming seriously ill if they get coronavirus, go into winter equipped to deal with their condition, keeping them well and out of hospital. Our roadmap to restoring basic care for respiratory patients aims to outline practical solutions for primary care and the support needed from NHS England.”

Dr Andy Whittamore, a practising GP and clinical lead for Asthma UK and the British Lung Foundation said: “The signs are pointing to a very difficult winter and it’s vital that people can access the care that they need to stay well. Prevention will play a crucial role in helping practices across the country manage seasonal pressures and support patients with lung conditions, including asthma and COPD, avoid urgent care. Annual reviews, a mainstay of lung disease basic care, need to resume to pre-covid levels. However, without guidance from NHS England, practices risk being overwhelmed by this backlog, unsure how to prioritise those most at risk.

“Practices will also be looking to NHS England to give clarity around identifying, diagnosing and treating new presentations of respiratory illness this winter and how primary care professionals can work through the backlog of diagnostic tests for suspected respiratory conditions.

“We want to remind and reassure anyone with a lung condition struggling with symptoms to seek help from their GP, delaying care could put your life at risk.”

Tracey Lonergan, Policy Coordinator for the Primary Care Respiratory Society said: “Restoring the range of necessary services for patients with respiratory disease is critical if we are to avoid an imminent crisis not only for patients but also for the stability and capability of the NHS to deliver the care they need.  NHS England needs to provide clarity and guidance for primary care practices seeking to deliver care for patients with respiratory illness during the coming winter season, complicated like never before by the ongoing Covid-19 pandemic.”

Read the report here:


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Notes to Editors:

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*Out in the cold: lung disease, the hidden driver of NHS winter pressure, British Lung Foundation report, December 2017 

**Data from asthma GP registers 2018/19, via NHS Digital (England), ISD Scotland, Stats Wales, Department of Health (Northern Ireland).  

***Asthma UK and the British Lung Foundation July COVID survey. Conducted 10-15th July, with 8,496 responses

About Asthma UK and the British Lung Foundation

Asthma UK and the British Lung Foundation merged on the 1 January 2020.

Asthma UK’s mission is to stop asthma attacks and, ultimately, cure asthma. We do this by funding world leading research, campaigning for improved care and supporting people to reduce their risk of a potentially life-threatening asthma attack. We are entirely funded by voluntary donations. For further information, please visit:

The British Lung Foundation offers hope, help and a voice to the 1 in 5 people in the UK affected by lung disease. We provide support and information to improve the everyday lives of people with lung disease. We are also campaigning for better diagnosis, treatment and prevention for now and the future. For further information, please visit