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The waiting game

Asthma phone reviews not allowed for QOF

Telephone reviews of asthma patients will not count towards quality achievement after an arbitration panel ruled there was 'insufficient evidence' to justify their use.

The panel rejected routine use of telephone reviews following arguments by PCTs that inhaler technique could only be checked in person. But the decision has prompted a furious reaction from GP respiratory experts, who called it a 'huge retrograde step'.

The Implementation Co-ordination Group panel ­ consisting of negotiators from the GPC and NHS Employers, and representatives of the Department of Health, said: 'The QOF group concluded the current evidence base is insufficient to support widespread use of telephone reviews in general practice. The ICG has upheld the recommendation of the QOF group.'

Dr Hamish Meldrum, GPC chair and member of the panel, said: 'Part of the review looks at inhaler technique ­ that was the real cruncher. Telephone review may be better than nothing but you can't say [technique] is OK.'

Respiratory experts warned the decision would compromise patient care as non-attenders would now be exception reported rather than reviewed.

Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire, and a hospital practitioner in respiratory medicine, said: 'We're all human and we want to do well in targets ­ if you can't get them in and you can't do telephone reviews you are going to look at exception reporting.'

Dr Kevin Gruffydd-Jones, a pioneer of telephone reviews and chair of the General Practice Airways Group's education committee, said: 'It is a huge retrograde step for the management of asthma. Care will deteriorate.'

Dr Gruffydd-Jones, who is a GP in Box, Wiltshire, rejected suggestions that evidence on telephone reviews was not generalisable to all practices.

Dr Hilary Pinnock, a GP in Whitstable, Kent, said: 'Inhaler technique does need to be assessed but it doesn't need to be addressed at the review. '

The issue was referred to the panel after a dispute between GPs and some PCTs, which refused to accept telephone reviews for QOF scores.

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