30 June 2022

Wales primary care clinical audit report 2017/2018

NACAP Front Cover

Results from the last wales report captured under the National COPD audit programme are also available.

A patient friendly report will also be published to accompany this more detailed clinical report. This report will be made available in April 2020 and will present key findings and recommendations for patients and their families and carers. It will be available in the downloads section at the bottom of this page in an accessible format compatible with screen readers.

A quality improvement (QI) slide set, focused on the key findings from the 2017/18 clinical audit, will also be made available in April 2020.

How to use this report

This report comes in two parts:

  • national primary care audit report – this presents key findings, quality improvement opportunities and recommendations
  • results and data analysis report (data report) – this contains the full data analyses from which the key findings and recommendations have been derived. The data are presented largely in tabular form, with explanatory notes throughout.

Whilst the results and data analysis report is available to the interested reader, it is not necessary to review this to appreciate the key messages within the national primary care audit report. We strongly advise discussion of these findings within and between GP surgeries at cluster level, and further review at health board level.

Please note that all appendices for this report, including the full methodology, can be found in the data report. The data report also contains the rationale (including the guidelines and standards that are mapped to) for the inclusion of each query.


The Wales primary care clinical audit report contains the key findings and QI recommendations
The Wales primary care data analysis and methodology report contains all data tables from which the key findings are taken, as well as a hospital benchmarking section and audit methodology.

Local health board and cluster reports

Wales primary care audit clinical audit 2017/18 patient report

This report presents key findings and recommendations for patients, their families and carers in a summarised and accessible format.

Quality improvement (QI) focused slide set

This slide set pulls together the key findings of the report, with a QI focus.

We identified the following QI recommendations for 2020:

For providers – COPD

  1. Ensure all patients with COPD diagnosed in the past 12 months have a record of a chest X-ray within 6 months. Patients without a chest X-ray should be sent for one. (NICE 2019 NG115)
  2. Ensure all COPD patients have evidence of post-bronchodilator spirometry showing an FEV1/FVC ratio of <0.7. (NICE 2016 QS10 (QS1))
  3. Ensure that patient exacerbations are recorded using the appropriate Read code (eg 66Yf).
  4. Ensure that patients’ breathlessness is graded during their COPD annual review using the MRC score. (NICE 2019 NG115)
  5. Ensure that patients with an MRC score of 3 and above are offered a pulmonary rehabilitation referral.

For providers – asthma

  1. Ensure all patients with asthma have evidence of objective testing (spirometry, peak flow (>1 reading or evidence of peak flow diary) or fractional exhaled nitric oxide (FeNO)) recorded. (NICE 2018 QS25 (QS1))
  2. Ensure that the patient’s best peak expiratory flow (PEF) is recorded. (NICE 2018 QS25 (QS1))
  3. Ensure that asthma attacks are recorded using the appropriate Read code (eg H33z0 or H33z1)
  4. Ensure that exposure to second-hand smoke is coded in every child and young person’s (CYP) notes (eg 137I0 or 13WF1–13WF4) and that asking whether a child is exposed to second-hand smoke becomes a routine question whenever they attend their GP about their asthma.
  5. Ensure that all asthma patients have a personalised asthma action plan. (NICE 2017 NG80)

For people living with COPD and/or asthma, their families and carers

  1. Make sure you tell your GP about your smoking status and whether you are regularly exposed to second-hand smoke.
  2. Make sure you visit your GP for an annual review of your asthma or COPD.

For a full list of the recommendations see our downloadable national report.