
The challenge
In 2019, the breathlessness pathway was identified by NHS England as a national priority for clinical re-design.
Similarly, the NHS long term plan highlighted the need to consolidate diagnostic services into hub and spoke network models, and better connectivity between diagnostic services and the digitisation of workflows.
In 2021, Queen Victoria Hospital NHS Foundation Trust (QVH) became an early participant in the Sussex Community Diagnostic Centre (CDC) programme, enabling it to play a key role in shaping the clinical approach to the breathlessness pathway for the region (based on NICE guidance and clinical best practice).
QVH partnered with Feedback Medical to initiate a pilot exploring Bleepa®’s capabilities to optimise the breathlessness pathway.
Bleepa® connects to healthcare IT systems bringing together results from the full spectrum of diagnostic tests (such as MRI, CT, X-ray, angiogram, ultrasound, spirometry, blood results) enabling case discussion, second opinion services, e-referral management, and virtual multidisciplinary team working.
Bleepa®’s ability to capture and align patient investigations with specific clinical pathways allows clinicians across both primary and secondary care settings to review, discuss, and manage patient cases more effectively.

Solution
The purpose of the pilot was to demonstrate the effectiveness of the redesign of the pathway. The project’s scope was clearly defined, which helped avoid any changes or unnecessary additions.
Goals for the pilot were:
- Enhancing GP access to diagnostic data and management plans.
- Providing better co-ordinated care.
- Reducing the need for in-person specialist appointments by enabling earlier, data driven clinical decisions.
- Reducing patient visits to hospitals through virtual collaboration.
- Getting people the right information at the right time rather than it sitting in silos.
By streamlining the sharing of diagnostic information and enabling timely collaborative decision-making, Bleepa® helped to ensure more rapid diagnosis and improved access and coordination of care, along with improved primary and secondary care consultation and collaboration.

As a result of the pilot, QVH offered patients convenient access to a range of diagnostic services closer to home, avoiding the need for multiple, or in some cases, unnecessary, visits to acute hospital settings.
Both financially and clinically, the project benefited from clearly identifying necessary resources:
- Professional – involving a cardiologist in the pathway as breathlessness may be respiratory or cardiology related or both.
- Infrastructure – establishing new physiological testing clinics for spirometry and FeNO to full lung function testing.
- Coordination – creating a pathway coordinator role, which helped to triage referrals, schedule tests in one go and prevent unexpected costs.
“As part of the QVH Breathlessness Pathway steering group, we provided the GP’s perspective to the team from the beginning. Our feedback was key to shaping the end-to-end process which is now streamlined, straightforward and well executed.
“Regular communication with all levels of staff – from GPs to teams across QVH – meant everyone had a voice and felt part of the process, which encouraged commitment and ownership.
“The pathway coordinator schedules the tests for patients on one day, meaning less trips to hospital and less time to reach a diagnosis. We receive a clear and concise summary of the outcome at the end of the patient episode, informing decisions for ongoing care. The pathway process is more efficient without any additional workload.”
Benefits
For patients, the benefits were clear – the project streamlined care by ensuring that all diagnostic information was gathered and shared quickly in Bleepa®, leading to faster treatment decisions and more coordinated care.
A significant proportion of patients had all their initial investigations completed on the same day, which minimised delays and reduced the number of repeat appointments. Additionally, the proportion of patients who could be managed back in primary care, versus those needing referral to secondary care, reflected the success in managing cases efficiently at a local level.
“The redesigned pathway has really helped to improve communication and collaboration between clinicians. Bleepa® has enabled us to review the results rapidly and have multi-disciplinary discussions virtually to expedite decision making.
It is easy to refer patients onto the pathway and to discuss and respond to the GPs with our recommendations.”

Key measurable improvements include:
- 63% reduction in patient wait times from referral to treatment for the breathlessness pathway compared to the 18-week national target (46 days compared to 126 days) – reducing the number of patients waiting for over six weeks.
- 45% reduction in referral to diagnostic test wait times.
- 90% reduction in outpatient appointment requirements
- 3 x no. of diversions to traditional advice and guidance
- 377k minutes of consultant time could be saved per pathway for an integrated care board
(ICB) - £315k-£787k could be saved per pathway for an ICB
Leveraging digital infrastructure through Bleepa®, this approach has achieved remarkable efficiency gains, releasing £4,230 per 100 respiratory referrals without requiring extra staff or CDC expansion. If these benefits were achieved more widely it could save Sussex ICS £314,880 or even £16.9 million nationally with one pathway.
Patient feedback was collected throughout and has been positive. This quote highlights the impact: “10/10 communication and referral process”.

Conclusion
By partnering with Feedback Medical and implementing Bleepa®’s secure messaging system, the project with QVH enhanced GP access to diagnostic data and improved care coordination. This holistic approach facilitated earlier, data-driven clinical decisions, resulting in a 63% reduction in patient wait times from referral to treatment, alongside a 90% decrease in outpatient appointments.
The integration of a diverse range of diagnostic tests enabled effective management of patients across primary and secondary care, ultimately leading to significant savings in consultant time and costs, and subsequently optimising the healthcare delivery model.
Throughout the process, the work carried out at QVH has been, and continues to be, showcased in multiple arenas through ICS and national webinars. The national diagnostic team became aware of the programme, which was very much supported by their leadership team through Prof Mike Richards.
The QVH breathlessness pathway was made a national exemplar, and the team has worked across NHS England with others aiming to emulate the programme.
The whole project has been included as a case study in the report by the All-Party Parliamentary Group for Diagnostics 2024 report on CDCs.
This approach provides a pioneering blueprint of the symptom-based pathway and the ultimate enabler to clinical re-design as it has demonstrated the ability to cut wait times and improve patient care.
“We are pleased with the success of the pilot programme, which has led to keen interest in us sharing the best practice with others to adopt similar symptom-based pathways. We have presented to leaders in NHS England and clinical teams in trusts and ICBs to share our key learnings and the core factors for success.
“We are looking forward to the next stage of rolling out additional pathways, ie non-site specific symptoms, and increasing adoption across Sussex ICB to maximise the clinical and efficiency improvements for our patients.”
Our CDC breathlessness pathway pilot with Queen Victoria Hospital NHS Foundation Trust
Feedback Medical CEO Dr Tom Oakley discusses our CDC breathlessness pathway pilot with QVH.