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GPs' quality pay threatened by discrepancy in COPD guidelines

GPs who follow draft NICE recommendations on chronic obstructive pulmonary disease will miss out on pay because of a glaring discrepancy between the guidelines and the new contract.

The consultation document from NICE rules out routine reversibility testing to confirm COPD. But the contract quality framework says GPs must use reversibility testing to earn the 10 points available for diagnosing COPD.

Those 10 points will be worth £750 to the average practice next year, rising to £1,200 the following year.

The draft NICE recommendation also conflicts with guidelines from the British Thoracic Society and the GOLD guidelines endorsed by the US Government and World Health Organisation. Both advocate reversibility testing to rule out asthma.

A spokesman for NICE insisted: 'On the basis of the evidence currently reviewed the guideline development group has formed the opinion that in most cases reversibility testing is unhelpful and may be misleading.'

But GPC negotiator Dr Mary Church said: 'GPs should feel quite confident doing what's in the quality framework ­ it really is evidence based.'

Dr Mark Levy, a GP in Middlesex and editor of the Primary Care Respiratory Journal, branded NICE's judgment 'against common sense'. He added: 'NICE is out on a limb on this.'

Dr Tony Crockett, a member of the General Practice Airways Group committee, said the rest of the guidelines were 'extremely clear and straightforward' but there was a consensus among GP experts that NICE had got it wrong on reversibility testing.

Dr Crockett, a GP in Swindon who is working on a COPD outcomes audit for the British Thoracic Society, said: 'Anything that can create confusion in GPs is not a good idea.'

Professor Martyn Partridge, immediate past-chair of the British Thoracic Society and professor of respiratory medicine at Imperial College in London, urged worried GPs to voice their concern to NICE.

He warnd: 'There is a danger people look at draft guidelines and take them as gospel.'

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