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Rapid Responses: Rapid Responses published:
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complexity on complexity
- Les Toop (7 January 2009)
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Re: complexity on complexity
- Dougal J. Jeffries (8 January 2009)
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Can NICE make improvements to QOF?
- Elizabeth C Harland (4 February 2009)
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Les Toop, General Practitioner and Head Of Department of Public Health and General Practice University of Otago, Christchurch
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It seems General Practice is losing its grip on the QOF micromanagement tigers tail. Hang on tight, it wont be pretty if (probably when) you let go. Does anyone have a vision of a QOF version of Holmes' simplicity beyond complexity? Perhaps no one gives a fig. Competing interests: None declared |
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Dougal J. Jeffries, gp Isles of Scilly TR21 0HE
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As Les Toop knows, I have mistrusted QOF from the start, and its true Trojan Horse characteristics are becoming increasingly obvious. As each target is generally attained, that target is removed from the equation and a new one introduced. More clinical and non-clinical areas are added, but of course no new resources are offered to meet this ever-expanding range of targets. Furthermore, the latest additions to QOF are no more evidence -based than many of their forerunners. While waiting for good evidence that routinely using depression scoring questionnaires improves the overall outcome of primary care patients with depression, we are already being told to carry out follow-up scoring. For some reason we are supposed to offer long-term reverisble contraception to all patients who seek contraceptive advice, despite relatively high rates of dissatisfaction with Implanon, and less so with the IUS, while the majority of young women are content with and sensible users of the combined pill. These are two examples: there are more. Now that NICE is getting in on the act, financial considerations will loom ever larger, and decisions about QOF will be made with less and less reference to the working GP. I am sick to death of it, and can't wait to retire. It's only the remaining (but diminishing) part of the job that I enjoy. Forget professionalism, based on judgement and conscientious practice. Good luck to the future apparatchniks of the Dept of Health. Competing interests: As an ageing GP, I have an interest in maintaining a degree of clinical autonomy and judgement, which is sorely threatened by the QOF. |
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Elizabeth C Harland, GP Principal King Street Surgery, 84, King Street, Maidstone, Kent ME14 1DZ
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The GP QOF is beginning to feel like a game of “Simon Says” run by the playground bully. We have little choice but to “join in” or else we risk our practice being featured in the local press as being the “Poorest Performing” in our area. The data collection required is becoming less evidence-based and more whimsical as the years pass.(What evidence is there that the manpower required to assess every asthmatic’s inhaler technique on an annual basis, is a cost-effective use of Primary Health Care time?). And are we now to be guardians of the nation’s dental care, being required to document “Dental Examination” for our patients with mental health problems or dementia?. Since the first year of QOF the “referee”(to change the metaphor) has, every year, revised the rules half way though the “match” - I mean: “current year of monitoring”. Is no one going to challenge this arrangement?. It would not be tolerated in any other sphere. This year, for example, we have been measuring and carefully documenting people’s BMI and advising them to lose weight, if they wish to improve their health, -as we have been doing for many years. Then, 6 months or more into the current period of screening, we find that we are expected to have measured the girth at the waist of all these folk, and if we have not had our crystal ball to hand, to see what the performance indicator would be, then we shall be penalised, and branded a “Poorly Performing Practice”. It seems that the ref and arbitrator of good practice has an unconstrained period of time in which to dream up the next hoops through which GPs must jump, and the hapless working GPs are suddenly confronted with new tasks to achieve in the remainder of the year until April 1st. These new demands then arrive on top of the annual flu epidemic and the burden of respiratory disease over the two winter quarters. Perhaps NICE, with its emphasis on evidence based medicine, will come to the aid of us beleaguered GPs, and insist that any new performance indicators are really evidence-based, and are declared at beginning of the year of screening, so that clinical time can be focused strategically on this disease prevention activity during the quieter summer months, when the burden of treating presenting illness is less. Competing interests: None declared |
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