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LETTERS: Anne Holmes Add carrying a card to QOF BMJ 2007; 334: 1179-c [Full text]

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Great Idea

Andrew J Ashworth   (8 June 2007)

Not an appropriate responsibility

Christian J Ward   (8 June 2007)

Re: Not an appropriate responsibility

Anne Holmes   (10 June 2007)

Great Idea 8 June 2007
Andrew J Ashworth, GP Davidsons Mains Medical Centre, EDINBURGH, EH4 5 BP Send response to journal: Re: Great Idea	What an excellent idea to actually use QOF to improve health instead of simply chasing outputs dressed up as outcomes by the Government. Perhaps the GPC of the BMA could seek suggestions for even more changes to QOF so that the annnual box ticking excercise might develop into a public health initiative! Competing interests: None declared
Not an appropriate responsibility 8 June 2007
Christian J Ward, Clinical Quality Programme Manager Derbyshire County PCT, S41 8RR Send response to journal: Re: Not an appropriate responsibility	I do not see the role of any healthcare professional as one which should be proactively encouraging the carrying of a donor card. I see the role of clinicians as one which should be proactively providing the infomation on organ donation to the patient (for the benefit of public health) to enable them to make their own informed choice as to whether to carry a card or not. Although it's important and necessary to try to increase the number of card carriers, to add a QOF target along the lines of the one in question rewards GPs on the basis of being able to persuade patients to donate their organs, and this is not the right approach. As with issues around consent, the role of the healthcare professional is to enable the patient to make an informed decision based on a thorough understanding of the facts. Since organ donation obviously has no health effect on the donor, giving opinions on whether to donate or not is not the premise of the clinician and where doing so could bring financial benefits this produces conflict of interest. Therefore, any target added to QOF relating to organ donation should relate more to whether clinicians have imparted the necessary factual information and then Read coded the decision of the patient; GPs cannot be responsible for the nature of the decision their patient's make on issues that have no consequence to the health of the patient in question. Competing interests: None declared
Re: Not an appropriate responsibility 10 June 2007
Anne Holmes, General Practitioner Tithebarn Medical Centre, Stockton on Tees, TS19 8RH Send response to journal: Re: Re: Not an appropriate responsibility	My intention was not to suggest that we should be rewarded for obtaining consent to donation and agree that would be completely wrong. I also recognise the need for fully informed consent if healthcare professionals are involved in the decision making process. However, I do not support the idea that all patients need a consultation with a healthcare professional in order to make a decision about donations. I do not see a conflict of interest in asking whether someone already has a donor card. This could be done by any staff member. Many practices already have donor card forms in their waiting room. When patients register with a practice, the application form already contains a question about organ donation. I do not know whether PCTs do anything with this information. If one signs up to be an organ donor on the website, there is a comment advising people to ensure that they have enough information to make that choice. Perhaps this should also apply to all of the consent forms. http://www.uktransplant.org.uk/ukt/how_to_become_a_donor/how_to_become_a_donor.jsp Competing interests: None declared