National Review of Asthma Deaths (NRAD)

While I agree with David Jewell that GPs are generalists, I don’t agree with the way he has apparently written off the recommendations, and I would urge against complacency with regard to the findings of the National Review of Asthma Deaths (NRAD).¹ He suggests the report and recommendations emanated from specialists: this was clearly not the case. To clarify, the process of the NRAD involved collaboration of a multidisciplinary steering committee with representatives from the Royal Colleges, respiratory societies (primary and secondary care), respiratory and allergy charities, as well as patient representatives.

I was the Clinical Lead, and am a practising GP (with 37 years of experience, 15 years as a single-handed doctor). The 174 confidential inquiry panel members were primary and secondary care doctors and nurses; they made 1000 recommendations based on close scrutiny and discussion of the 276 sets of medical records of people who were certified as having died from asthma. Furthermore, the final report was a collaborative effort, with input from over 20 representative groups, including the Primary Care Respiratory Society who made 13 recommendations for change within a separate chapter in the report.

I understand clearly that we are working under extremely difficult, under-resourced conditions in the current economic climate. Nonetheless, the findings and recommendations applied to care provided by primary and secondary care. Preventable factors in over two-thirds of asthma deaths have been repeatedly identified in studies for over 50 years; and it is really time to take appropriate action and change the way care is being provided.

• © British Journal of General Practice 2014