Exclusive GPs can refer patients requiring spirometry for an asthma diagnosis to secondary care in order to achieve QOF points from April, the BMA has advised.
GPs will be expected to restart all QOF activity from next month, as QOF payments will not be protected beyond the end of March.
Under changes to QOF for 2020/21, GPs are now required to use spirometry to diagnose asthma alongside previous requirements for diagnosing COPD – corresponding to a total of 23 QOF points.
But joint guidance from the BMA and RCGP on practice workload prioritisation in place since January lists spirometry as a ‘red’-rated procedure, meaning it can be postponed until the end of the pandemic.
The guidance said the ‘red’ category represents ‘lower priority routine work which could be postponed in the event of a high prevalence of Covid-19 in your patient population, aiming to revisit once the pandemic ends, ensuring recall dates are updated where possible’.
BMA GP Committee chair Dr Richard Vautrey told Pulse that the prioritisation guidance still applies, but that there is ‘no obligation’ under QOF for practices to do spirometry from April.
Practices can ‘refer patients to local services’ instead, he added.
He said: ‘All activity that is done for the patient, regardless of where it is done, counts towards QOF. This would be the case for a diabetic or COPD review done by a hospital.
‘If the patient has diagnostic spirometry for COPD done by a community or hospital service that counts towards QOF indicators.’
But practices still risk missing out on cash if the test is not completed or they are not informed that it has been done, as points are based on asthma diagnoses with ‘a record of spirometry’.
QOF indicator guidance requires ‘the percentage of patients with a diagnosis of asthma on or from 1 April 2021 with a record of spirometry and one other objective test (FeNO or reversibility or variability) between three months before or six months after diagnosis’.
However, COPD patients with no record of tests ‘will not be excluded from the register’, with the ‘expectation’ that ‘over time, the proportion of patients with spirometry in the diagnostic range will increase’, it said.
It comes as GPs have warned that some practices could lose income when the four flu indicators in QOF being retired and replaced with new incentives in the Investment and Impact Fund (IIF) from April.
Meanwhile, it was revealed earlier this month that GP practices will not be able to exclude any eligible patients when reporting against the new childhood vaccinations and immunisations QOF indicators that come in from next month.
QOF indicators requiring spirometry
AST006 – 15 points:
The percentage of patients with asthma on the register from 1 April 2020 with either:
1. a record of spirometry and one other objective test (FeNO or reversibility or variability) between 3 months before or 6 months after diagnosis; or
2. If newly registered in the preceding 12 months with a diagnosis of asthma recorded on or after 1 April 2020 but no record of objective tests being performed at the date of registration, with a record of spirometry and one other objective test (FeNO or reversibility or variability) recorded within 6 months of registration.
COPD009 – 8 points:
The contractor establishes and maintains a register of:
1. Patients with a clinical diagnosis of COPD before 1 April 2020 and
2. Patients with a clinical diagnosis of COPD on or after 1 April 2020 whose diagnosis has been confirmed by a quality assured post bronchodilator spirometry FEV1/FVC ratio below 0.7 between 3 months before or 6 months after diagnosis (or if newly registered in the preceding 12 months a record of an FEV1/FVC ratio below 0.7 recorded within 6 months of registration); and
3. Patients with a clinical diagnosis of COPD on or after 1 April 2020 who are unable to undertake spirometry
Source: 2020/21 GP contract