Respiratory QOF changes come in to force next week

Primary care clinicians are reminded that important changes to respiratory QOF indicators introduced by the new GP contract become effective from April 1.

The changes are:

• A new COPD indicator for offering pulmonary rehabilitation (PR) to patients with COPD and a 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 MRC 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.  

PCRS Executive Chair Dr Noel Baxter says: “PCRS welcomes the move towards QOF being used as a basis for quality improvement. “This will enable the collection of respiratory data in general practice to be used as a basis for investigating how the quality of care can be improved.  However we are concerned that we don’t have an audit for asthma and COPD in England from which we would obtain the necessary data to reflect on what should change and how we monitor that.

“We also welcome the addition of a QOF indicator on PR and believe this will provide an important stimulus to local areas reviewing and expanding their provision of PR. PR is an intervention with a significant evidence base and is more cost effective than many medications. However, in the Wales COPD primary care audit 39.1% (32, 295) did not have MRC recorded in the last year. If practices don't improve the quality of annual reviews and pay more attention to breathlessness management then people who should be in the denominator group, suitable for PR, will still be missed and not get access to this intervention.

“We agree with removing the requirement to undertake spirometry on all people with COPD annually (COPD 004) because we agree that measuring FEV1 has limited value in determining the progression of COPD on its own. There is a poor correlation between lung function and severity so time released from performing this task could enable a more comprehensive and patient centred approach to the annual review.

“We support the removal of COPD 005 because oxygen saturations are now well-recorded and reflect a considerable success story for quality improvement in the last 5-10 years where pulse oximetry has shifted from being rarely used to now being business-as-usual. 

“It is disappointing that overall we have lost 12 points from respiratory indicators and only gained two with the new indicator on PR. However PCRS will be working with NICE during 2019/20 to develop a better set of indicators for asthma and COPD for implementation from 2020.”