Mass opt-out fear as rule change hits child vaccine pay
After GPs' spectacular performance in the inaugural QOF, they might have been hoping to pause for breath and perhaps a spot of self-congratulation.
But respiratory experts are increasingly warning their area of medicine has missed out on the party, with a clutch of new studies highlighting deficiencies in care for asthma and COPD.
Last week, experts held a high-level meeting with the Department of Health at which they pushed for respiratory disease to attain the same status
in primary care as cardiology or diabetes.
'Respiratory has certainly had a raw deal,' said Professor David Price, a GP in Norfolk and professor of primary care respiratory medicine at the University of Aberdeen.
'If we look at the burden of respiratory disease we still see massive poor control of asthma, increasing morbidity and mortality from COPD.'
Dr Kevin Gruffydd-Jones, chair of the General Practice Airways Group's education committee, said: 'To a certain extent diseases like COPD have been Cinderella diseases. There is a perception that not a lot can be done.'
The figures back their case. UK mortality from respiratory disease is almost double the European average, according to the Chief Medical Officer.
And while deaths from ischaemic heart disease have plummeted in the last decade, respiratory deaths have fallen much more slowly (see graph, far right).
Two studies published this week lay out the extent of the challenge facing GPs.
Latest results from the Eastern Region Confidential Enquiry into Asthma Deaths, first reported by Pulse in July, highlight the problems posed by patients with difficult asthma, many of whom have significant psychosocial problems.
The inquiry, published online this week by the Primary Care Respiratory Journal, rated medical care as 'appropriate' in just a third of deaths. There were even signs the situation was worsening, with an increase in the proportion of cases involving inadequate doses of steroids or failure to refer to a specialist.
'There's been a realisation that we've not been doing as well as we thought,' said Dr Gruffydd-Jones, who is a GP in Box, Wiltshire.
A second new study, reported in Pulse this week, found palliative care for COPD was largely inadequate, with many patients denied the opportunity to die at home.
Dr Steve Holmes, chair of the General Practice Airways Group and a GP in Shepton Mallet, Somerset, called for Government action: 'With COPD, mortality and morbidity rates are going up. It's difficult to know why that hasn't reached the strategic advisers' awareness.'
Lung organisations last week met with the department and interested bodies such as the MRC and Wellcome Trust to push for a renewed focus on respiratory health.
Dr Mark Britton, chair of the British Lung Foundation, said targets had distorted clinical priorities. 'With the Government driving health care on targets all the attention is being addressed to achieve those targets.'
Dr Britton, consultant physician at Ashford and St Peter's Hospital in Chertsey, added: 'We're working very hard to alert the Government to the fact respiratory medicine is being neglected.'
Professor Andrew Peacock, chair of the British Thoracic Society's communications committee, said: 'Politically what we need is an NSF for chronic lung disease as there is for ischaemic cardiac disease. That would focus attention of managers, which would filter down to GPs.'
Experts said an NSF could focus on issues such as pulmon-ary rehabilitation, lung function testing and the availability of ambulatory oxygen.
But Dr Britton acknowledged that such a framework would require a 'tremendous resource commitment'.
Professor Peacock said the BTS had come away from the meeting frustrated: 'We had a feeling there was no agenda for change.'
GP respiratory experts are also pushing for a greater place in the QOF for COPD and asthma. They have suggested points for at-risk registers of asthma patients, written personal action plans, use of peak flow in diagnosis, pulmonary rehabilitation and checking inhaler technique.
But GPs are keenly aware new guidelines and directives will have no effect unless extra workload is properly resourced.
'There need to be guidelines for the management of asthma that are nationally recognised and we need the resources for that,' Dr Gruffydd-Jones said.