QOF results are misrepresenting COPD care in primary care, report warns

High QOF scores have provided 'false assurance' on the quality of COPD services in primary care and steps must be made to improve diagnosis and treatment of the disease, according to a report.

Spirometry (Photo: Jim Varney)
Spirometry (Photo: Jim Varney)

Improvements must be made in primary care to make COPD diagnosis more accurate and cut down on ‘high cost, unsafe and clinically ineffective treatments’ being provided to people who do not actually have COPD, according to a national report assessing primary care in England.

The National COPD Audit Programme analysed QOF and Public Health England (PHE) data for 2014/15 on practices in England, in addition to audit data extracted from Welsh practices – the first time primary care data on COPD has been audited.

The report – commissioned in 2013 and prepared by the Royal College of Physicians alongside the RCGP and Primary Care Respiratory Society UK – was initially intended to audit data from across the whole of the UK, but was set back due to limitations on data extraction in England.

The findings suggest that some of the most clinically and cost-effective treatments for COPD – such as treatment for tobacco dependency, targeted pharmacological treatment and pulmonary rehabilitation – are being underused.

COPD care

The report calls for ‘the accurate and early diagnosis of COPD’ to be prioritised and for GPs to take a ‘person-centred approach’ to ensure that patients with severe forms of the disease are identified for optimal therapies.

Better coding and recording of COPD diagnosis, treatment and referral ‘is imperative’, and people with a confirmed diagnosis should be offered the treatment that will ‘provide them with the best outcome in the most cost-effective way’, it adds.

Across the UK, 1.2m people have been diagnosed with COPD, making it the second most common lung disease in the country. It is the cause of death for 30,000 patients each year.

Dr Noel Baxter, a GP respiratory specialist and clinical lead for the RCP's primary care workstream, said: ‘It will come as no surprise to people working in and with general practice who are interested in outcomes for people with COPD that the high achieving QOF results have provided false assurance about the quality of care for these people.

‘Detailed, coded data from Welsh general practice has raised the alarm about how confident we can be about the metrics we are measuring and, subsequently, about what is actually happening in terms of the quality of diagnosis and the utilisation of the right interventions.

‘Given the current inability to extract similar data for England, this report has sought to tell a story for England. We recommend CCGs urgently look at their local data following the concerns raised in Wales. It is time for England to be serious about measuring the quality of care for people with COPD.’

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