New QOF guidance on asthma tests aligns itself with NICE recommendations

Advice on asthma diagnosis has been updated under newly published QOF guidance for 2025/26 so it no longer conflicts with separate UK joint guidelines issued last autumn by NICE.

GP practices were left facing confusion last November after long-awaited UK asthma guide produced by NICE, the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN)  revealed significant changes to recommendations on testing, which were different to QOF advice.

However, now the two have been reconciled – QOF guidance published last week has replaced indicator AST011 that refers to initial diagnosis with a new one, AST012. Points and targets for the indicator remain unchanged (see box below).

‘This indicator was updated… to reflect the recommendations made within the new combined asthma guideline produced by the BTS, NICE and the SIGN in November 2024,’ the guidance has said.

It added: ‘A combination of a suggestive clinical history and a supporting objective test is needed to diagnose asthma, with different objective testing sequences for adults, and children and young people aged 5 to 16.’

Effectively, this now means that for adults and over 16s, GPs are advised to use a stepwise series of tests including eosinophil count, FeNO, spirometry and bronchial challenge in patients where the condition is suspected on clinical grounds.

To achieve QOF points in 2024/25, GPs were expected to have a record of quality assured spirometry and one other objective test, such as FeNO or, bronchodilator reversibility or peak flow variability, between three months before or six months after diagnosis. They were also expected to do two objective tests in new patients joining the practice who have a diagnosis of asthma but no record of tests being done.

Professor Azeem Majeed, head of primary care and public health at Imperial College London and a GP in South London, told Management in Practice he welcomed the two guidelines now being reconciled and the fact that ‘QOF guidance has been updated so quickly and in time for the 2025/26 financial year’.

He added that he didn’t expect that the conflicting NICE guidance would have had much effect on QOF performance for asthma in 2024/25, since it was published late last year and practices would already have been working to the QOF targets.

Swindon GP Dr Gavin Jamie and who runs the QOF database  website said the change in diagnosis of asthma from doing several tests together to doing them in sequence ‘will be a change for practices and will require some new learning, but no more than other guideline changes’.

He added: ‘QOF has actually been simplified here. We don’t have the full rules yet but the guidance says that any of the tests will count for this indicator, and it is likely to be a single test rather than the two that were required in the past’.