GP contract introduces key respiratory QOF changes

The new five year GP contract has introduced some important changes to the respiratory QOF indicators, effective from April 2019 in England.

The changes reflect a major review of QOF which has resulted in some low value indicators being retired, the introduction of some more clinically appropriate indicators and a greater focus on quality improvement.

The contract also reflects the direction of travel of the NHS Long Term Plan with information about how primary care networks will operate and about some of the new roles being introduced in primary care, including clinical pharmacist, advanced practice physiotherapists, and physician assistants.

The key changes to the QOF respiratory indicators are:

• A new COPD indicator for offering pulmonary rehabilitation (PR) to patients with COPD and a Medical Research Council (MRC) dyspnoea scale ≥3 at any time in the preceding 12 months. (2 points).
• Two COPD indicators are being retired:
  • COPD 004: The percentage of patients with COPD with a record of FEV1 in the preceding 12 months. (7 points).
  • COPD005: The percentage of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months (5 points).   
• Smoking indicator, SMOK 003, is to be retired on the grounds that supporting people to stop smoking is now part of core professional practice.  

A more detailed review of the COPD and asthma indicators will be undertaken in 2019/20 commencing with a meeting in February 2019. PCRS will have a seat at this table and will play an active role in shaping an improved set of indicators for respiratory disease from 2019/20.

PCRS Executive Chair, Dr Noel Baxter, says: “We are pleased to see the addition of a pulmonary rehabilitation indicator to QOF. This is a very high value evidence based intervention which should stimulate discussion at local level about how best to provide PR for all eligible patients. The denominator for this indicator does rely on systematic measurement of breathlessness using MRC breathlessness scores every year, and the National COPD primary care audit for Wales indicated that over a third of patients with COPD did not have a record of their breathlessness in the last year and so they could be omitted from the denominator.”

“As for the retirement of two COPD indicators, it is now well recognised that FEV1 is not useful as a standalone test in determining the progression of COPD as there is a poor correlation between lung function and severity of disease. We also hope that its removal as an indicator will encourage a more holistic and patient centred approach to the annual review. Oxygen saturation is being measured fairly routinely according to the National COPD audit in primary care in Wales, so the quality improvement opportunities now lie elsewhere. So we support the removal of both these indicators.”

“We think it’s really positive that treating tobacco dependency is now regarded as a mainstream activity for general practice, and look forward to seeing how a shift from QOF to core impacts on the delivery of this treatment.”