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NHS Direct to do asthma reviews

NHS Direct is to be allowed to review GPs' asthma patients by telephone even as practices themselves are barred from doing so.

The move – funded by a pharmaceutical company – has been seen as provocative by GPs, who were told they could not review patients by phone for the purposes of the QOF.

Some GPs also worried it could fragment care and steps on the toes of general practice.

NHS Direct has announced that the new scheme – sponsored by AstraZeneca - will involve inviting all practices to allow NHS health advisors to follow-up patients on Symbicort every six to 12 months by telephone.

GPs will receive a report after each review, which is not intended to replace GP care, but to pick up on any problems with dose or inhaler use, according to NHS Direct.

The General Practice Airways Group has been pushing for the Department of Health to recognise the usefulness of phone reviews for asthma by including them in the QOF.

But last year the QOF implementation group said there was ‘insufficient evidence' to support such services.

Dr Kevin Gruffydd-Jones, GP in Box, Wiltshire and member of the GPIAG, supported the use of telephone reviews for patients with asthma, but questioned why NHS Direct could undertake the scheme when GPs were not able to do under the QOF.

‘It's very much for the Government agenda of patient choice, it's cost-effective – we have got all the evidence so it's a mystery why it's not in the QOF.'

He said NHS Direct's record on acute care did not inspire trust in GPs and tele-phone reviews were a more appropriate job for GPs or practice nurses: ‘There is a danger this scheme could fragment care and I'm not sure how it fits in.'

Professor David Price, professor of primary care respiratory medicine at the University of Aberdeen, said the scheme was ‘possibly helpful' but needed to pick up the right information.

‘If poor control is found it is essential that the patient has the reasons for poor asthma control examined,' he said.

Anne Joshua, associate director of pharmacy at NHS Direct said they were keen to run similar programmes with other pharmaceutical companies.

Phone Telephone reviews for asthma - the history Telephone reviews for asthma - the history

Feb 2006 - Only face-to-face reviews included in the QOF for patients with asthma

March 2006 - Implementation Co-ordination Group panel concluded the current evidence base was ‘insufficient' to support the use of tele-phone reviews in the QOF

Aug 2007 – Strongest evidence yet that telephone reviews are effective, cheaper and improve patient confidence, according to a study in 2,000 patients

Oct 2007 - NHS Choices announces new scheme to offer telephone reviews to patients with asthma

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