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The audit of allergy services undertaken by clinical immunologists1 is a welcome reminder of the important role that clinical immunologists have in the delivery of allergy care in the UK. It usefully informs the present Department of Health review that represents a once-in-a-generation opportunity to get important new investment in NHS allergy services. This review care about as a result of a sustained lobbying campaign by the British Society for Allergy and Clinical Immunology (BSACI) in concert with the patient groups represented by Allergy UK and Anaphylaxis Campaign. The clinical immunology audit complements and adds further detail to the analysis of all the allergy services in the UK, undertaken by the BSACI,2 for the health select committee based on its comprehensive database of allergy clinics, including those provided by clinical immunologists. The two surveys come to essentially the same conclusions. Firstly, in terms of new patients seen, the clinical immunology and allergy communities have about equal capacities for new patient referrals and secondly, the services vary widely in their size. For example, Preston has a capacity of 220 new referrals a year as compared with the 2500 new patients seen in Cambridge. Neither survey is designed to say anything very useful about the quality of care provided other than the intuitive expectation that the more resources available the more comprehensive the service.
The central point to take away from both surveys is the woeful lack of overall capacity. After an exhaustive analysis of the available evidence, the BSACI3 has concluded that in excess of three million people in the UK would benefit from specialist advice on the diagnosis and management of their allergic disease. The total annual capacity for new referrals in the UK is about 50 000, which means there is a considerable unmet need. This is a powerful argument for increased investment in allergy services. The key question is how that new investment should be made. The BSACI has argued consistently that investment should be targeted in a way that increases capacity most cost effectively. The BSACI therefore fully supported the conclusions of the 2003 Royal College of Physicians4 report on allergy services that the key priority for new investment is the creation of a geographically comprehensive network of adult and paediatric allergy centres, a conclusion also endorsed by the Joint Committee on Immunology and Allergy. It is vital if we are to persuade the Department of Health of the need for new investment that the stakeholders in allergy provision speak with one voice. I was therefore delighted that the vision of a network of allergy centres was unanimously re-endorsed at a recent meeting of allergy stakeholders hosted by the President of the Royal College of Physicians, where the clinical immunology community was again represented by the Joint Committee on Immunology and Allergy.
There are several ways in which an allergy centre can develop maximising the local available skills, including those of clinical immunologists. It is essential that the allergy and clinical immunology communities and other providers of allergy services work in close harmony to make our joint vision of high-quality NHS allergy services come to life.
Competing interests: None declared.
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