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Base asthma QOF on action not tick boxes

The proposal to move conditions such as asthma in and out of the QOF surely misses the point.

This framework needs to become much more than a tick-box exercise if it is to significantly improve the patient experience and achieve Lord Darzi's vision of high-quality care for all.

While there is much excellent practice and the QOF has led to some improvement in asthma care, the asthma indicators can be met without anything actually happening to benefit the patient.

For some, an asthma review is a planned and comprehensive annual check-up that explores compliance, measures peak flow and assesses inhaler technique.

For others, it is little more than 'how are you today?'. The recent review of the QOF in the new GMS contract was a missed opportunity to include indicators on self-management plans or a rehearsal of inhaler technique.

Some GPs argue that the QOF rewards treat asthma care as second rate, leaving only those interested and motivated by asthma seeking to improve standards.

Patients tell us they experience huge variations in asthma services depending on where they live, which setting they are seen in and by which health professional. This results in widespread variation in the number of emergency hospital admissions for asthma.

In order to achieve real and lasting improvements to asthma services in primary care we must see QOF standards that are based on actions, not tick boxes, with an independent and transparent process for producing and reviewing indicators and a much greater focus on outcomes.

Then we can consider rotating conditions in and out of the framework.

Neil Churchill, Chief executive, Asthma UK

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