GPs neglecting their own health
GPs who try to claim points for diagnosing COPD without reversibility testing face a
Government-ordered clampdown during quality visits.
In a statement to PCTs, the Department of Health admitted a loophole existed in the Read codes that could allow GPs to claim quality pay by doing spirometry alone.
But it urged PCTs to check this was not happening during GPs' annual reviews.
GPs said the clampdown was 'petty' and would force them to practise medicine that was 'not very good' in order to claim quality pay. They said the disparity between the quality indicators and NICE guidance which says reversibility testing can be misleading was 'very confusing'.
The statement, posted on the website of the National and Primary Care Trust Development Programme, said: 'Contractors need to do spir-ometry and reversibility testing. PCTs should check this issue as part of the annual review or pre-payment verification process.
'The Q&O has not chan-ged and practices should either follow its requirements in full or opt out of any indicators they believe are not in the best interests of their patients.'
The department said the only way GPs could claim COPD points without doing reversibility testing was to have 'explicit agreement' from their trust and its auditors, which it felt was 'unlikely'.
Dr Tony Crockett, a GP in Shrivenham, Wiltshire, and hospital practitioner in asthma and COPD, said: 'It's very confusing. The advice given in the NICE guidelines would say you do not need to do reversibility testing. But that doesn't help us when we are trying to get our quality points.
'My advice at the moment is, if you want to get quality points then do reversibility testing even though clinically it's not very good medicine.'
Dr David Bellamy, a member of the NICE guidelines committee on COPD and a GP in Bournemouth, said: 'I think it's a bit petty. Some PCTs will say "Yes, okay, that is what NICE has said", but it will vary.'
GPC deputy chair Dr Laurence Buckman said: 'It is inevitable that a few [indicators] have worked differently from the way they were intended to.
'The Q&O is about paying [GPs] and best medical evidence. There is no confusion - if you want to be paid
then you do what the Q&O says.'
There are 10 quality points available for diagnosing COPD, worth £750 per average practice in 2004/5 and £1,200 in 2005/6.
Ministers order pay veto for GPs who follow NICE on COPD