General practice teams are facing confusion over different approaches to asthma diagnosis set out in the QOF and in the new UK joint guidelines.
In the recent update, NICE, BTS and SIGN guidelines revealed significant changes to current approaches including the tests used to diagnose asthma.
It advised clinicians to use a stepwise series of tests including eosinophil count, FeNO, spirometry and bronchial challenge in patients where the condition is suspected on clinical grounds.
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Under the recommendations asthma can be diagnosed if the eosinophil count is above the laboratory reference range or the FeNO level is 50 ppb or more.
Other objective tests can then be done if asthma is not confirmed, the guidelines said, while also recognising that practices have limited access to diagnostics in the community.
But under QOF, clinicians are expected to have a record of quality assured spirometry and one other objective test, such as FeNO or, bronchodilator reversibility or peak flow variability, between three months before or six months after diagnosis
To achieve points practices are also expected to do two objective tests in new patients joining the practice who have a diagnosis of asthma but no record of tests being done.
Asthma experts said there was unlikely to be a change to QOF mid-year, leaving teams in conflict between two sets of guidance.
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Dr Steve Holmes, a GP in Shepton Mallet and Somerset ICB clinical respiratory lead, said it would be up to the QOF team to consider how to address the lag between the indicators and the new NICE guidance.
‘I would hope that QOF will adjust rapidly and it would be sensible to ask if they can do this or how they hope practices to manage the situation.’
An NHS England spokesperson said: ‘The NHS works closely with the National Institute for Health and Care Excellence to review the Quality and Outcomes Framework indicators as part of the annual GP contract cycle, and to update them where necessary to align with the latest clinical guidance.’
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A version of this article was initially published by our sister publication Pulse
