The findings come from an analysis of QOF scores and standardised emergency admission rates for PCTs in England in 2004, the year the framework was introduced.

This showed that the 5 per cent of PCTs with the highest emergency hospital admission rates for asthma - 79 per cent above the national average - achieved around 87 per cent of the possible score for asthma.

However, the 5 per cent of PCTs with the lowest admission rates - 51 per cent below the national rate on average - achieved nearly 94 per cent of quality points for asthma.

In its report, Asthma UK said that much of the variation in emergency admissions for asthma was linked to the quality of care patients received.

Three quarters of the 67,700 admissions in 2004 could have been avoided with appropriate and timely care, saving the NHS £43.7 million, the report claimed.

Judith McAllister, a community respiratory specialist nurse and trainer in Peterborough, Cambridgeshire, was surprised by the figures, as most of the QOF were awarded for 'tick-box outcomes'.

'But I think the QOF has helped practices become more proactive and recall patients for a review, whereas before they would have waited for them to come in for something else.'

Ms McAllister added that poorer quality scores were usually a result of the practice nurses who reviewed asthma patients not having the appropriate training.

'Unfortunately, the numbers of nurses accessing training is decreasing because of PCT deficits and GPs feeling they can still earn enough money without their nurses having the specialist knowledge,' she said.

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