Published 6 May 2009, doi:10.1136/bmj.b1813
Cite this as: BMJ 2009;338:b1813

Letters

Quality in primary health care

The shaman and QOF

The first 150 words of the full text of this article appear below.

Heath and colleagues use a case study of a person who has hypertension and a complex tale which includes oesophageal cancer, bronchiectasis, and a sorry family history to question whether the achievement of a blood pressure of 150/90 mm Hg in any way assesses quality of care.1 We don’t know what the patient’s blood pressure is, and, more crucially, what the patient wants to do about it.

The quality and outcomes framework (QOF) is explicit about exemption reporting: if the patient does not wish to have treatment she can be exempted at no loss to practice income. It is then up to the doctor to discuss with the patient what she wants to do about her blood pressure, not decide for her. QOF is then about empowering patients rather than invoking professionalism and complexity, which can encourage doctors to continue in their paternalistic ways. Appealing to complexity, and therefore almost . . . [Full text of this article]

Chris Gunstone, general practitioner1

1 Burton on Trent DE14 2JA

chris.gunstone@nhs.net


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Quality in primary health care: a multidimensional approach to complexity
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