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Dr Steve Quilliam sees little choice but to risk the wrath of consultants by block referring up to 100 of his patients on a single letter. Dr Quilliam, a GP in Prudhoe, Northumberland, said he would otherwise miss quality points for testing lung function in patients with COPD.

His practice was recently left unable to carry out testing after the PCT failed to replace a nurse who was trained in spirometry. 'It seems over the top to refer to a consultant. I would look at how many need spirometry ­ maybe 100 ­ and consider a block referral.'

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