If this new national allergy strategy is the map, then Goal 1 is the compass.
Equitable access to high-quality, lifelong allergy healthcare – and an NHS workforce educated and trained to deliver this
GOAL 2: The Process
The Standards of Care and Patient Pathway working group was tasked to address equitable access to allergy healthcare. Key questions were ‘What does good look like?’ What constitutes high quality allergy healthcare? How can we provide lifelong access? and How do we ensure a highly trained and competent NHS workforce with which to deliver it? Members of the working group were asked to nominate 5 top objectives which were grouped into sections and ranked in order of importance, to create recommendations.
The National Allergy Strategy and Goal 2 relate to all health frameworks and long-term plans across the four nations of the UK. This includes alignment with NHS England’s 10-year plan, ‘Fit for the Future’, particularly the shift of care from hospital and community and the development of ‘Neighbourhood health centres’, providing services closer to home and improving accessibility. Fortunately, allergy care can perfectly align with this. The integration of allergy services into all Neighbourhood health centres, supported by multidisciplinary teams, forms a key part of our recommendations, enabling specialist, hospital-based allergy services to support more complex conditions.
The working group established 26 priority objectives, each supported by strategic actions, and grouped into five sections. These were: Equitable access to high quality care, Services for adolescents and young people (aged 11-25), Workforce provision, Development of community provision and Workforce education and training.
Equitable access to high quality allergy care will require Government investment. The economic case for improving allergy services in the community needs to be developed, alongside guidance for commissioners to better understand the needs of allergy patients and the economic benefit of providing community-based allergy services. Allergy services need to be integrated into long term condition planning at Government level and supported by setting clear national and local accountability for allergy provision.
Allergy needs to be embedded within commissioning and performance frameworks, with UK‑wide service standards established that define what good care looks like in primary, secondary and tertiary settings, including the multidisciplinary skills and diagnostics they must provide. Service standards need to be underpinned by a wide variety of guidelines and standards of care, and inclusive of all professional groups involved in allergy care. National benchmarking programmes will support quality improvement. Pathways and standards of care can be monitored by frameworks such as IQAS and the BRIT registry. A benchmarking scheme for paediatric allergy services will need to be developed. All services struggling to meet standards for delivery will be supported through the development of a culture of shared learning and systemic quality improvement.
Unequal access to allergy care needs to be addressed. Geographical variation in patient demand and access to services can be mapped and disparities used to target investment and service development. This can also be supported through the development of allergy capability within Primary care, to resolve less‑complex allergy, safely and closer to home. This will require defined competencies, GPs with extended roles (GPwER), access to clinical nurse specialists, allergy dieticians, psychologists and pharmacists, appropriate allergy testing and interpretation, and clear referral criteria. This may also involve the creation of regular virtual MDTs to support allergy provision in primary care. Allergy management in Neighbourhood health centres will reduce waiting lists for hospital-based services enabling specialist clinics to focus on complex needs. This will improve outcomes for all allergy patients.
Not only is it important to expand the reach of allergy services, access to disease‑modifying therapies must also be equitable and timely across every nation. Referral pathways will need to be aligned to national guidance and monitored to ensure delivery. This requires national, standardised referral criteria, aligned with the NHSE service specification, and should be provided by a network of services covering the whole country. In addition, greater access to services providing testing for drug and anaesthetic allergy, alongside a national programme for penicillin allergy de-labelling will improve care for patients with drug allergy.
Services for adolescents and young people (aged 11-25) is the second priority. Young people must experience safe, uninterrupted transition from paediatric to adult services, with defined competencies for the care of young adults. National service standards for transition are now defined in IQAS and the paediatric service standards. Core competencies for personnel working with adolescents and young adults need to be defined. Adult allergy services supporting transition must be mapped and gaps addressed. Healthcare transition in all allergy pathways needs to be embedded and underpinned by evaluation and audit. Improved digital integration in the NHS 10-year plan will lead to better data collection and clinical coding, and a better understanding of the needs and provision of allergy care for adolescents and young people.
The remaining three priorities are centred on workforce. Firstly, the development of a multi-professional NHS workforce in sufficient numbers, and with appropriate skills to meet the needs of all affected by allergy. Support from the Government will allow the allergy workforce to be expanded and upskilled at all levels; medical, nursing, dietetic, psychology and pharmacy. In order to achieve this, the final two priorities are to develop effective education and training from undergraduate to post graduate level for all healthcare professionals involved in the delivery of allergy care. This will be achieved by increasing training numbers, creating flexible development and post graduate training routes. Through the BSACI’s “LearnAllergy” platform, the BSACI Allergy Education Network (BAEN), Allergy Capabilities Framework can ensure appropriate allergy education at all levels. Allergy should be included as core educational content for all healthcare professionals, supported by the best use of digital initiatives.
The result of addressing these five priority areas will be that people living with allergic disease can access timely, high quality care throughout their lives, wherever they live in the UK. Care will be provided by an NHS workforce, trained and organised to deliver it close to the patient’s home, avoiding long trips to distant centres. Care providers will work within a supportive network delivering high quality, standardised allergy services across the country. Expansion of allergy services will be informed by enhanced data.
Dr Isabel Skypala
Royal Brompton Hospital
Dr. Isabel Skypala has worked in the field of food allergy at the Royal Brompton Hospital for more than 30 years. After initially treating both children and adults, she established a dedicated adult food allergy service in 2008 and, in 2014, became the UK’s first Consultant Adult Allergy Dietitian.
Her research has focused primarily on plant food allergies, including Pollen Food Syndrome and Lipid Transfer Protein (LTP) Allergy, and she has authored more than 70 peerreviewed publications and books. Dr. Skypala also contributes to academic training, teaching on several Allergy MSc programmes and lecturing nationally and internationally.
She is an active member of the British Society for Allergy & Clinical Immunology (BSACI) and participates in international allergy societies, including the European Academy of Allergy & Clinical Immunology and the American Academy of Allergy, Asthma and Immunology (AAAAI). Over the past two decades, she has played a central role in advancing the dietitian’s contribution to food allergy care by supporting the development of allergy specialist groups across the UK, Europe, and worldwide.
Dr. Skypala received the BSACI William Frankland Award for services to clinical allergy in 2014 and the AAAAI Allied Health Professional Recognition Award in 2022. She currently serves as CoChair of the BSACI Standards of Care Committee.
Dr Susan Leech
Paediatric Allergist
Dr Susan Leech is a former Paediatric Allergist at King’s College Hospital, London. She completed her specialist training in paediatric allergy and immunology at the University of Oxford and King’s College London. During her tenure at King’s, she served as Clinical Lead for the Paediatric Allergy Service and founded the South Thames Paediatric Allergy Network.
Dr Leech has held several national leadership roles, including serving as the allergy training advisor for the Royal College of Paediatrics and Child Health (CSAC) College Specialty Advisory Committee. She also chaired the Paediatric Allergy Committee of the British Society for Allergy & Clinical Immunology (BSACI) and previously served as a BSACI trustee.
She currently CoChairs the BSACI Standards of Care Committee and has coauthored multiple national guidelines.
