GPs face huge gaps in COPD funding

A lack of PCT investment in the 'gold standard' treatment for COPD is undermining patients' quality of life and increasing practice workload, a GP investigation has found.

Dr Holmes: 'Why are we ignoring the evidence when we are desperately trying to save money?' (Photograph: D Chadwick)

Figures obtained by GP show pulmonary rehabilitation, a treatment proven to keep COPD patients out of hospital, is being hugely underfunded in many parts of the country.

The GPC has asked commissioners to prioritise the service in light of demands on GPs to reduce emergency admissions under targets added to the QOF from 2011/12.

GP obtained figures from 91 PCTs using the Freedom of Information Act. These showed that 42 times fewer patients accessed pulmonary rehabilitation in some parts of the country than others in 2010/11.

One PCT budgeted just £10,000 for the service this year - compared with up to £451,209 elsewhere. Even after accounting for population size, the difference in funding was 25-fold.

Evidence shows attendance at the service can slash hospital admissions and repeat GP consultations. Reducing emergency admissions is a QOF target for 2011/12 and 2012/13.

GPC deputy chairman Dr Richard Vautrey said: 'It is a concern that despite the strong evidence that pulmonary rehabilitation is beneficial for patients with COPD there is such a wide variation in access to and use of this service.' He added: 'At a time when there is such a focus on avoiding unnecessary admissions it would seem that this is an area that all PCT clusters and clinical commissioning groups (CCGs) should prioritise.'

Between 2009/10 and 2010/11, the average number of patients using PCT-commissioned pulmonary rehabilitation services jumped from 77 to 112 per 100,000 people registered with a GP.

Despite this, just 14 patients per 100,000 GP-registered people attended courses in NHS Gloucestershire, the lowest ranked trust, in 2010/11. This compared with 574 patients in NHS Liverpool.

Somerset GP Dr Steve Holmes, education lead for the Primary Care Respiratory Society, said: 'People should be asking why we are ignoring the evidence when we are desperately trying to save money and improve efficiency.'

Dame Helena Shovelton, chief executive of the British Lung Foundation, said the variation in access to pulmonary rehabilitation found by GP reflected the picture on the ground and was 'worrying and unacceptable'.

'For patients it is viewed as the single most important treatment - the combination of education and exercise gives people more confidence managing their condition.'

She said it was important for GPs to refer to the services to cut hospital admissions and boost patients' quality of life.

  • 42-fold difference between PCTs in the numbers of patients accessing services, adjusted for population size.
  • 25-fold variation in per capita funding between PCTs.
  • 64% of 91 PCTs did not know how much they had budgeted for pulmonary rehabilitation alone in 2011/12.
  • 43% could not say how many patients had used the services.

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