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Gold, incentives and meh

GMC should learn from other professions

Three-quarters of asthma deaths are not sudden and could be prevented with more rigorous medical care, a confidential inquiry has concluded.

The inquiry called for GPs to set up at-risk registers after finding 'inadequate follow-up' and 'inappropriate management' of vulnerable patients.

Care only rated as 'appropriate' in a third of deaths from asthma, leading to accusations of complacency from one GP respiratory expert.

But the inquiry team stressed that the vast majority of deaths were in patients with serious psychosocial problems and GPs vigorously defended the standard of their care.

The Eastern Region Confidential Enquiry, the largest of its kind in the world, reviewed 57 confirmed asthma deaths from 2001/3 in a population of 5.25 million.

In 75 per cent of cases the final asthma attack was not sudden and 'may have been preventable', according to the inquiry, presented at the annual General Practice Airways Group (GPIAG) conference this week. In 81 per cent of cases, significant psychosocial and behavioural problems contributed to the patient's death.

Some 61 per cent related to poor compliance, 46 per cent to smoking, 37 per cent to denial of the condition, 20 per cent to depression and 20 per cent to alcohol abuse.

The inquiry, interim findings of which were reported by Pulse last December, concluded: 'Better recognition of the combination of severe asthma with psychosocial risk factors is required. In hospital and in primary care there continue to be problems with inadequate follow-up, lack of specialist care and inappropriate management of these patients.'

The GPIAG said it had submitted proposals to the quality framework review team for specific quality points for holding an at-risk register.

The Healthcare Commission said it would 'carefully consider' the findings from the inquiry, which has previously fed into British Thoracic Society guidelines on asthma.

Dr Paul Stephenson, a GP member of the inquiry team and a former committee member of the GPIAG, said: 'There is now good evidence to say "Should we be trying to identify those at-risk patients?".' But he insisted GPs overall were doing 'damn well' on asthma care.

Dr Hilary Pinnock, responsible for GPIAG's submission on quality points for at-risk registers, said: 'These people have many, many problems.'

Professor Aziz Sheikh, head of primary care research and development at the University of Edinburgh, said: 'Patients are being undertreated. Rather than ascribe blame it's important we draw on effective interventions.'

But Dr Tony Crockett, a GP in Shrivenham, Wiltshire, and a hospital practitioner in asthma and COPD, said: 'We've got complacent about asthma. We forget it can be fatal.'

By Daniel Cressey

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