National arbitrators for the GP contract are to rule on whether telephone reviews for patients with asthma can count towards Quality and Outcome Framework targets following two primary care trusts’ decision to disallow them.
West Wiltshire PCT and Kennet and North Wiltshire PCT have told practices that telephone reviews for patients with asthma will not count as achievement of indicator six of the QoF on asthma.
The indicator measures “the percentage of patients with asthma who have had an asthma review in the last 15 months” with payment triggered when 70 per cent of those on the register have had a review.
The decision has infuriated local GPs, including Dr Kevin Gruffydd-Jones, a GP with a special interest in asthma and lecturer at Bath University who this month published a study in the British Journal of General Practice showing the effectiveness of telephone reviews.
He told EHI Primary Care that his study had found that telephone reviews allowed practice to see 35% more patients at 37% less cost. He added: “The point is by using the telephone you can identify those who need to be seen face to face. I find the stance of our PCT absolutely unbelievable. They have overridden what our negotiators have negotiated and when presented with the evidence that telephone triage is very efficient they have backed themselves into a corner and refused to move.”
In a statement to EHI Primary Care Debra Elliott, director of primary care for the PCTs, said that the PCT believed reviews should be held face-to-face and include a review of inhaler technique and peak flow. She said the local medical committee also believed patients should be seen face to face.
The statement adds: “The PCT support this view and add that they would also expect that a personalised asthma plan be agreed with the patient to assist them in the self management of their asthma.”
However Dr Nigel Watson, chief executive of Wessex LMCs, said that while the LMC believed face to face consultations were the “gold standard” the committee fully supported the use of telephone reviews.
He added: “It’s actually a better use of doctors’ time in triaging those who don’t need to come in and then seeing those who are poorly controlled.”
Dr Gruffydd-Jones said the evidence from his study was that 88 per cent of patients preferred to be reviewed over the telephone.
He added: “The Quality and Outcomes Framework sets a target of 70 per cent but there is another 30 per cent of patients who are not being seen who are probably the most high risk patients. With telephone triage it’s not just that you see more patients and you do it at less cost but that you also see those who you would otherwise never get in.”
In her statement Elliott said that while the PCT recognises that telephone review does play an important part in management of patients with asthma the PCT did not believe it constituted achievement of indicator six.
She added: “If practices aspire to provide this service on top of the face to face assessments then the PCT would have to consider this as a potential enhanced service. This enhanced service would then be expected to contribute to a review target over and above the 70% stated in the QoF. Obviously any proposed enhanced service would have to be assessed against all other priority areas that the PCT are asked to address to improve the health of the population and cannot be viewed in isolation of the wider health agenda.”
The issue has now been referred to the national Implementation Coordination Group which rules on matters of dispute in the new contract between practices and PCTs.
Dr Laurence Buckman, deputy chairman of the British Medical Association’s General Practitioner Committee, told EHI Primary Care that most PCTs in the country were allowing telephone reviews.
He added: “The science is clear and there’s published evidence that shows that telephone reviews are reliable.”