Today, the Royal College of Physicians (RCP) has published a report looking at the clinical effectiveness of chronic obstructive pulmonary disease (COPD) care in primary care in England.
Chronic obstructive pulmonary disease (COPD) inflicts a huge toll on individual patients, their carers, and on the NHS. In total, 1.2 million people in the UK have been diagnosed with COPD, making it the second most common lung disease in the country. Along with lung cancer and pneumonia, COPD is also one of the three leading contributors to respiratory mortality in the UK; there are 30,000 deaths from the disease each year, 25,000 of which are in England.
This report, which follows publication of a Welsh primary care audit report in October, combines publically available data from 2014-15 for England with pertinent audit data extracted from Welsh general practices.
Data presented in this report demonstrates that accuracy of COPD diagnosis needs to improve to avoid high cost, unsafe, and clinically ineffective treatments being provided to people who do not, in fact, have COPD. In addition, the report suggests that some of the most clinically and cost-effective treatments for COPD, including treatment for tobacco dependency, targeted pharmacological treatment, and pulmonary rehabilitation, are being underutilised.
The report sets out the following key recommendations to support improvement in COPD care within a primary care setting:
- Accurate and early diagnosis should be prioritised;
- People with a confirmed COPD diagnosis should be offered the treatment that will provide them with the best outcome in the most cost-effective way;
- A person-centred approach is vital in ensuring that those with more severe disease are identified for optimal therapies;
- Better coding and recording of COPD diagnosis, treatment and referral is imperative.
Finally, the report outlines a wide variety of quality improvement resources to support primary care clinicians in England to deliver the standard of care to people with COPD. In doing so, this report aims to provide a springboard for primary care to make sure that people get the correct diagnosis and receive effective treatment, regardless of who they are or where they live.
Dr Noel Baxter, clinical lead for primary care work stream said:
It will come as no surprise to people working in and with general practice who are interested in outcomes for people with COPD that the high achieving Quality and Outcomes Framework (QOF) results have provided false assurance about the quality of care for these people.
Detailed, coded data from Welsh general practice has raised the alarm about how confident we can be about the metrics we are measuring and, subsequently, about what is actually happening in terms of the quality of diagnosis and the utilisation of the right interventions.
Given the current inability to extract similar data for England, this report has sought to tell a story for England. We recommend CCGs urgently look at their local data following the concerns raised in Wales. It is time for England to be serious about measuring the quality of care for people with COPD.