Quality framework changes not funded

Use of proteinuria tests for CKD and COPD diagnosis by post-bronchodilator spirometry.

Changes to the COPD and chronic kidney disease (CKD) domains of the quality frame-work came into force this week, but for no extra income.

Under the 2008/9 quality framework, which came into force on 1 April, GPs will be expected to diagnose COPD using post-bronchodilator spirometry, rather than reversibility testing. At the same time the points for the COPD diagnosis indicator are halved to five.

Dr John Haughney, president of the International Primary Care Respiratory Group and a GP in Glasgow, said: 'Diagnosis is the bedrock of disease management and I don't agree that points should be reduced.'

While post-bronchodilator spirometry is key for assessing severity of COPD, he added: 'I would encourage people to do reversibility if they need that to make a positive diagnosis.'

Other changes released four days before GPs were expected to implement them, included proteinuria tests in CKD.

This follows on from NICE draft guidelines on CKD released last month, which called for proteinuria tests to gauge if patients are to be given ACE inhibitors or angiotensin receptor blockers (ARBs).

Under the framework, GPs are now to assess if CKD patients have both hypertension and proteinuria before prescribing the anti-hypertensives. No extra points have been awarded.

East London GP Dr Penny Ackland, who has an interest in CKD, welcomed the inclusion of proteinuria in the CKD domain, as it is a good indicator of kidney function.

But, she said: 'In the climate that we're creating for GPs I think it's hard to get anything done without payment for it.'

Dr Richard Vautrey, deputy chairman of the GPC, said the changes would have little impact on workload.

'We were going to make changes to the quality framework for heart failure, peripheral arterial disease and osteoporosis, but this was lost due to the imposition,' he said.

'We need to think about the future of the quality framework and how to maintain it as a valuable resource.'


Quality framework 2008/9

Changes to the quality framework 2008/9

  • Stroke and TIA patients referred for investigation in one month, rather than 12.
  • Diagnose COPD with post-bronchodilator spirometry not reversibility testing.
  • Test patients with CKD and hypertension for proteinuria before giving ACE-inhibitors or ARBs.
  • ECG diagnosis of AF in three not 12 months.
  • Smoking indicators also cover patients with CKD or psychoses.
  • Minor changes have been made in mental health, asthma and palliative care.
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