GPs given 48 hours to chase every asthma admission

Practices have been told to follow up every patient who suffers an acute asthma exacerbation within just two days, a plan criticised for promoting 'tick box' medicine.

NICE's new standard calls for patients with acute asthma exacerbation to be seen by their GP within two working days

A new 'gold standard' target set by NICE says patients who received hospital or out-of-hours treatment for an acute exacerbation of asthma should be followed up by their own GP practice within two working days of treatment.

The target forms part of a new NICE asthma 'quality standard', which describes best practice and aims to drive up quality of care.

Practices are likely to be judged on their performance against the target, as commissioners in turn will be judged against progress on quality standards from April.

GPs must also make sure patients receive a structured review at least once a year.

Somerset GP Dr Steve Holmes, education lead for the Primary Care Respiratory Society, said it was concerning that ‘such a clumsy indicator’ has been included in the standards.

‘Surely some complex patients would more appropriately be followed up in two days by a specialist or their team, and others followed up in two weeks,' he said. 'Our patients are individuals not tick boxes and we should manage them as such.’

'Blanket standard'
Dr Holmes said he would prefer patients to be sent home with medication and an informative discharge letter, having been taught how to use their inhaler correctly.

Alternatively, a follow-up should be arranged in an appropriate environment, such as a GP practice or with a specialist, at an interval thought to be appropriate for the patient's needs -  rather than a 'blanket standard', he said.

The proposal was first introduced in asthma management guidelines jointly produced by SIGN and the British Thoracic Society for the NHS in Scotland, and has been adapted by NICE for its new standards.

Dr Gillian Leng, deputy chief executive and director of health and social care at NICE, said: 'Asthma is a common lung disorder in the UK and can have a significant, negative effect on a person’s quality of life. NICE is pleased to be publishing this new quality standard on asthma, which contains eleven statements that will contribute to improving the quality and experience of care for those with the condition.'

Professor Sue Hill and Dr Robert Winter, joint national clinical directors for respiratory disease, said the standard was a 'great step forward'. 'If we address the areas of care highlighted in this quality standard, then we should see significant improvements in outcomes for people living with asthma and their overall quality of life.'

The British Lung Foundation welcomed the standard. Its chief executive, Penny Woods, said: 'We hope that, by outlining priority areas for quality improvement, this new quality standard document will mark a significant step towards the kind of world-class care everyone working in the industry wants for the four and a half million people living with asthma across England.’

The quality standard also calls for more integration between asthma services across the NHS.

The standard also requires GPs and the wider NHS to ensure:

  • Adults with new onset asthma are assessed for occupational causes.
  • People with asthma receive a structured review at least annually.
  • People aged five years or older presenting to a healthcare professional with a severe or life-threatening acute exacerbation of asthma receive oral or intravenous steroids within one hour of presentation.
  • People with difficult asthma are offered an assessment by a multidisciplinary difficult asthma service.

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