Redesigning the breathlessness pathway: How Queen Victoria Hospital and Bleepa are shaping NHS outpatient reform
The recent announcement from the UK Government confirming the out of hours services at 100 community diagnostic centres (CDCs) marks a significant milestone in national aims to increase diagnostic capacity, speed up elective care and bring care closer to local communities.
Queen Victoria Hospital NHS Foundation Trust (QVH) was recognised as part of this achievement for delivering productivity improvements via its CDC with a redesigned, straight-to-test breathlessness pathway.
With Bleepa® – a clinical collaboration platform – as the technology enabler, a new, digitally enabled model for breathlessness patients was developed by QVH in partnership with Feedback Medical.
The outdated patient model
The traditional outpatient model – referral, first appointment, diagnostic booking, review appointment – was never designed for today’s demand. As Feedback Medical CEO and NIA Fellow Dr Tom Oakley put it in a recent HSJ webinar, it ‘really hasn’t aged well’. It locks patients into multiple visits, delays decision-making, and consumes precious consultant time.
For integrated care systems under pressure to deliver elective recovery targets, this model is unsustainable. NHS England has made it clear: the system must move to straight-to-test, digitally enabled pathways that reduce outpatient activity and improve productivity. The CDC programme is a key part of increasing diagnostic capacity and moving care closer to home to facilitate these reforms.
Straight to test, enabled by technology
Breathlessness is one of the most common, and most complex, symptoms seen across the NHS – often requiring multiple specialties and diagnostic inputs, long waits and repeat appointments. It accounts for 5% of A&E presentations, 4% of GP consultations, and 12% of medical admissions.
QVH, as part of the Sussex CDC programme, and Feedback Medical re-engineered the breathlessness pathway with three design principles:
- Diagnostics first – Patients are triaged into a one-day package of relevant tests (respiratory, cardiac, or both) where possible.
- Digital integration – Bleepa pulls diagnostic imaging and test results into one platform, accessible across primary and secondary care.
- Virtual multidisciplinary decision-making – Respiratory physicians and cardiologists collaborate asynchronously in Bleepa to agree patient management plans without the need for unnecessary outpatient visits.
A pathway coordinator role was created to streamline triage and scheduling, ensuring patients avoided fragmented, piecemeal appointments.
Results aligned to NHS system priorities
The pathway has delivered measurable impact:
- Reduced traditional 20-30 minute outpatient appointments to 6-10 minute online reviews, meaning five times more respiratory patient interactions can be achieved in the same amount of time.
- 92% reduction in outpatient referrals, avoiding unnecessary appointments and freeing up clinical capacity.
- Streamlined patient journeys with 63% reduction in referral to treatment times compared to the national target, improving patient experience while reducing unnecessary delays.
“With Bleepa as the technology enabler, this has optimised and automated multiple steps on the pathway with greater visibility of where the patient is on their care journey to multiple people across the clinical teams.”
These results show how by rethinking our approach to pathways, supported by digital architecture, we can optimise use of CDCs to relieve pressure on hospital-based services and reduce waiting lists. It can help ICSs meet both the elective recovery target of 118% activity and the financial challenge of delivering ‘more for less’.
From local pilot to system blueprint
This project has been acknowledged with an HSJ Partnership Award in 2025 for Effective Contribution to Clinical Redesign and is shortlisted for Partnership of the Year at the HSJ Awards 2025.
The scalability is clear. By embedding Bleepa as a collaboration platform to enable a single point of access across ICSs, systems can flexibly manage referral activity, integrate advice and guidance, and rationalise waiting lists – without overburdening hospital providers.
Policy meets practice
The breathlessness pathway is a strong example of how community settings can be reimagined to deliver more productive, patient-focused care. This approach is now being adapted across a range of conditions and extended to other GP practices, CDCs and hospital sites – offering a scalable model for improving NHS productivity at a time when it is most needed.
“I think this is not just a fantastic way of redesigning elective care and improving the efficiency of elective care, it’s also a fantastic way of connecting disparate teams into a much more integrated way of working around a population.”
At Feedback Medical, our focus remains on partnering with the NHS to design and deliver holistic, digitally enabled care models that improve outcomes, streamline pathways, and unlock the potential of CDC settings as the programme continues to deliver against policy objectives across the UK.
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