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The diagnosis of COPD should be transferred wholesale to specialist respiratory centres as GP practices lack the resources to cope, a new study concludes.

Practices rarely had the equipment or trained staff to deliver high-quality COPD care, researchers found.

Just 54 per cent of practices owned spirometers and only 15 per cent had staff who were formally trained in using them.

Study leader Dr Robert McKinley, senior lecturer in general practice at the University of Leicester and a GP in the city, said spirometry training was essential. 'Poor-quality data means GPs make poor-quality decisions. People may be denied referral who need it and people may be referred who do not need it,' he said. 'We believe these results support the move to develop intermediate care services for people with COPD. It will free practices from the need to develop and maintain care.'

He insisted GPs could still be paid quality points for organising care even if they referred patients to diagnostic clinics. The GPC agreed this might be feasible.

The survey of 147 practices in Leicestershire, published in the Primary Care Respiratory Journal (February), found 46 per cent of practices had COPD protocols and just 8 per cent ran clinics.

Dr McKinley said care was likely to have improved since the new contract but that training remained an issue.

Dr Tony Crockett, a GP in Shrivenham, Wiltshire, and hospital practitioner in asthma and COPD, said: 'It sounds like they have highlighted how poorly COPD has been managed. The level of expertise is not good and certainly nothing to be proud of.'

Dr Dermot Ryan, a GP with a special interest in respiratory medicine in Loughborough, Leicestershire, said: 'Use of spirometers is a bit

suspect. There are still training issues in primary care.'

GPs can earn five points for a COPD register, 10 for diagnosis with reversibility testing and 30 for ongoing management.

By Nerys Hairon

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