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What breathtakingly useless guidance


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There are two ways to approach NICE’s new asthma guidance (there’s actually a third way, which is to run away screaming, but then technically that’s not an approach).

One is to scan it with a wry smile that at times becomes a full-on guffaw. For example, when you read that, regarding questions about occupational asthma, you should ‘make sure all answers are recorded for later review,’ which is a useful prompt, because I normally hate cluttering up the patient record with facts.

Or when NICE says: ‘Offer a FeNO test to adults (aged 17 and over) if a diagnosis of asthma is being considered.’ Because that means I can have the following conversation: ‘Mr Smith, I am considering in your case a diagnosis of asthma and would like to offer you a FeNO test to confirm this. Would you like that?’ ‘Yes please doctor, that would be lovely.’ ‘Well, you can’t have it.’

The other way to approach the guidance is to step back, take a deep breath and try to make sense of the labyrinth of tests which NICE requires us to negotiate before we can boost our QOF asthma prevalence by one. In which case, the conclusion we’re forced to reach is that, while we’re used to NICE being unrealistic, this takes it to levels which, appropriately enough, take your breath away.

We're used to NICE being unrealistic, but this takes it to levels which, appropriately enough, take your breath away

It’s possible, of course, that NICE is absolutely right to drive a coach and horses through asthma diagnosis, even if it does result in a sea-change so oceanic that I simply cannot summon the energy and enthusiasm to get my act together. Or maybe it is simply over-reacting to a problem that barely exists, and would do well to ponder on why we GPs do what we do, and have done for years, rather than be swayed by those who know much about academia but nothing about the frontline.

Whatever. The new guidance can be summed up by one word, and that is, ‘useless’. Because, whatever you think of the quality, there has to be practicability, too. And given that the management algorithms mandate a test which we cannot access, the guidance has no practical use.

Conflict of interest: I am asthmatic. At least, I think I am.

Dr Tony Copperfield is a jobbing GP in Essex


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Readers' comments (11)

  • We have enough trouble already persuading patients or their parents that 'that cough might not be an infection, and no a 7th antibiotic is not what you need. So we are going to send you for some tests and wait another few weeks before we get the answer. Please phone on my half day if you are not satisfied.'

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  • Healthy Cynic

    NICE must have some of the best-informed, most well-educated fools in the country on it's panel.

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  • The problem is all this comes at a price. If we don't follow the ever growing ream of NICE guidelines there can be risks of complaint, legal action or even GMC trouble. It also comes at a price for patients as ever more limited money is spent on writing and disseminating this nonsense. Not only that but it creates a democratic deficit as they stand in the way of governments being accountable for the rationing decisions they create. I think we'd be better off spending this huge resource on primary care which is proven to improve outcomes on a population basis and currently being driven off a cliff edge.

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  • Copperfield, you are not asthamatic till you know you have a Fe-No, you know !!

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  • Made my day

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  • NHS England investigations require GP practices to be ‘NICE compliant’. Disclosing that you view this guidance as utter tosh would merely confirm that there is a lack of insight on the part of the practitioner and accelerate referral to a NCAS ‘forced re-education through labour’ camp.

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  • Dear A&E
    I have just seen this child who may have asthma, At 8 years old she cannot blow into a peak flow meter, She is blue and struggling for breath. I think I can hear a slight wheeze in her chest but it is so quiet (I cannot hear any breath sounds clearly. Her pulse is 180, she has subcostal, tracheal and rib recession.
    Normally I would give her nebulised salbutamol and steroids but she has not diagnosis of asthma so could you please see her and arrange spirometry and FeNO tests. (preferably before she expires)
    Many thanks

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  • N ational
    I nstitute
    C linical
    E xcrement

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  • There is always SIGN :)

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  • I feel this is a nice should focus on the benefits for a moment. F... Off cause ur stupid!

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