Here’s why GPs in the NHS usually refer patients first to a local specialist (e.g. a local respiratory team) rather than directly to a national centre like the National Aspergillosis Centre (NAC):
🏥 1. The NHS Referral Pathway Is Tiered (Local → Regional → National)
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The NHS is designed to escalate care through “levels”:
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GP → Local Consultant → Tertiary/National Centre
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This structure ensures efficient use of resources and prioritises local care where appropriate.
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National centres are not intended to be the first point of contact, except in emergencies or highly specialised pre-agreed pathways.
🧠 Analogy: You don’t go straight to a brain surgeon for a headache — you start with your GP.
📝 2. Referral Criteria for NAC Require Specialist Input
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The NAC (based in Manchester) is a nationally commissioned tertiary centre, which means:
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It only accepts referrals from consultants (not GPs directly)
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It expects that basic tests (CT scan, IgE, Aspergillus-specific IgE/IgG, eosinophils, spirometry) have been done
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Local teams should attempt initial diagnosis and management, and refer on if the case is complex, resistant, or unusual
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📄 The NAC’s referral form specifically asks for consultant details and supporting investigations.
⚖️ 3. Clinical Governance and Local Responsibility
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Local respiratory consultants are responsible for:
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Ruling out common conditions first
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Starting standard ABPA or CPA treatment (e.g. steroids, itraconazole)
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Monitoring early response
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This ensures that patients who are referred to the NAC are those who really need advanced care, e.g.:
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Antifungal resistance
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Multiple relapses
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Atypical radiology
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Drug intolerance or failure
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Need for biologics, surgery, or MDT input
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🧭 4. NHS Resource Planning and Fairness
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National centres are funded to manage only the most complex or rare cases across the UK.
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If GPs referred patients directly, national centres would become overwhelmed — and many patients would bypass the local care they actually need.
💡 It’s not about gatekeeping — it’s about managing capacity and focusing expertise where it’s most needed.
🛠️ What Can Patients Do?
If you suspect ABPA or CPA and your GP doesn’t know about NAC:
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Ask to be referred to a local respiratory team — ideally one with fungal disease knowledge.
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Share NAC information NAC referral criteria & guidance, Support for professionals
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If already under a consultant and you’re not improving, ask:
“Would you consider referring me to the National Aspergillosis Centre for specialist input?”
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If you’re already diagnosed with ABPA or CPA and not improving, you can request your consultant refer you to NAC, citing lack of progress or drug intolerance.
