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At the heart of general practice since 1960

Q&O set for last-gasp change

The Department of Health is considering 11th-hour changes to GP quality and outcomes indicators for chronic obstructive pulmonary disease following a report from the National Institute for Clinical Excellence.

The changes ­ which would make some quality points more achievable ­ will be urgently discussed by the department, the NHS Confederation and the GPC.

New NICE guidance on the condition published last week cast doubt on the value of reversibility testing, which is required for diagnosis under the new contract and which is worth five points ­ £375 for the average practice this year.

The guidance states that reversibility testing 'is not necessary as part of the diagnostic process' and 'may be misleading or unhelpful'.

It says a COPD diagnosis can be made on the basis of history, examination and spir-ometry in previously untreated patients.

Targets for assessment of patients' smoking cessation status, symptom control and inhaler technique have also been set higher in the guidance than in the GP contract.

GPC negotiator Dr Ham-ish Meldrum said: 'We have an agreement that the quality and outcomes framework will not have any major revisions until 2006, unless there is something dangerous in them. We can't have a situation where every new guideline that comes out leads to a shifting of the goalposts.'

But a department spokes-man said: 'The contract agreement allows us to change individual indicators ahead of the main quality and outcomes framework review to take account of sudden changes in the evidence base.'

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