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CAMHS won't see you now


Nearly a third of patients on COPD registers do not actually have the disease, a Government-funded study suggests.

The findings have led COPD experts to urge GPs

to re-audit their registers to confirm every diagnosis, and make sure they are trained

in interpreting spirometry results.

They added failure to comply properly could leave GPs facing PCT investigation over QOF scores for COPD.

Audit investigator Angela Evans, a respiratory physiologist, found 30 per cent of the 450 patients on practice COPD registers in North Stoke PCT had normal spirometry results when tested and should not have been on the register.

The initial results from the six-month audit appeared

last week in the Govern-ment's Chief Scientist Office bulletin.

Dr Kevin Gruffydd-Jones, a GP in Box, Wiltshire, and education lead for the General Practice Airways Group, said access to spirometry was still an issue but the main problem was lack of training in interpreting results.

'Where we are diagnosing COPD or asthma it is very important to have spirometry. Even after auditing our register several times we are

still finding people on the list who don't have COPD,' he said.

NICE guidance on COPD tells GPs to use spirometry to confirm COPD before treating patients. It also earns QOF points.

Dr David Bellamy, a respiratory GPwSI in Bourne-mouth and a member of the NICE guidelines committee on COPD, said problems with access and training meant some singlehanders passed spirometry work on to secondary care because of workload.

Professor Martyn Partridge, professor of respiratory medicine at Imperial College London, said all GP registers must be re-audited, and added: 'The problem is as

big for asthma as it is for COPD.'

Dr Tony Crockett, a GP in Shrivenham, Wiltshire, and an adviser to the British Thoracic Society's COPD outcomes audit, warned some PCTs could use the findings to attack GPs' QOF scores. 'It could happen if you have an unscrupulous PCT looking to nit-pick.'

By Daniel Cressey

Spirometry tips

·Observe the patient to make sure technique is adequate ­ watch for slow start and inadequate effort

·Use a spirometer that provides at least a volume-time trace and preferably a flow-volume trace as well

·Use the trace as well as the figures to interpret

·Consider further training

GPs can obtain the BTS 'Spirometry in Practice' guide from

or download it from

Source: GP Airways Group/National Respiratory Training Centre

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