NICE attacks QOF for promoting poor COPD care
NICE has launched a stinging attack on the QOF review for compromising patient care by failing to overhaul indicators on COPD.
The institute condemned the review for rebuffing demands to bring COPD targets in line with its guidance on best practice.
Members of the institute's COPD guideline development group said the QOF targets were 'poor medicine' and should be followed only as a bean-counting exercise.
They particularly attacked the way the QOF defines COPD, criticising its insistence on use of reversibility testing and the FEV1 threshold it sets for diagnosis.
The QOF says an FEV1 of under 70 per cent of predicted and less than 15 per cent response to a reversibility test are key. NICE defines COPD as an FEV1 of less than 80 per cent of predicted and is unconvinced by reversibility.
Dr Peter LittleJohns, NICE clinical and public health director, warned: 'Where the revised QOF is not fully reflective of NICE guidance, there need to be clear reasons why, if patients are to feel confident that their care is being managed according to the best available clinical evidence.'
Dr David Halpin, chair of the NICE COPD guidelines group, said reversibility without reference to clinical features could lead to misdiagnosis.
He said: 'On this point, I would agree the contract leads to poor medicine. If reversibility testing is necessary to gain
QOF points, then don't let the results compromise patient care.'
The criticisms from NICE came as the General Practice Airways Group and the British Thoracic Society issued a joint statement warning the QOF was encouraging GPs to 'ignore' patients with mild COPD.
Dr Iain Small, chair of
the General Practice Airways Group's education committee and a GP in Peterhead, Aberdeenshire, said: 'It is worrying that one Government sponsored organisation is ignoring the evidence-based conclusions of another.'
He added: 'QOF is the only guide of which I am aware which goes for FEV1 of 70 per cent. There can only be one reason for this to reduce the size of our registers for COPD.'
Dr Mary Church, GPC negotiator and a GP in Glasgow, rejected the criticisms. She said: 'The QOF group is informed by experts. It doesn't preclude GPs following NICE guidelines if they wish.'