How much are doctors worth: is doctors' self interest undermining the NHS?BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39126.512836.47 (Published 15 February 2007) Cite this as: BMJ 2007;334:343
The Quality and Outcomes Framework has rewarded GPs for doing work that they don't like and that their patients don't want or value. Part of the QOF has made us streamline the professionalism in the back offices. It has put us through hoops to improve processes such as staff management and risk assessment.
The other half of the QOF has rewarded us for improving surrogate outcomes such as blood pressure and cholesterol in high risk patients. It has also rewarded us for clinical work that is less evidence based, like providing checks for people with newly diagnosed cancers.
What the QOF has not done is ask us to provide, and fund, what patients really want. Sadly, people don't value preventive medicine. People don't appreciate a GP's surgery tracking down men in their 40s who have been lost to follow-up after a coronary bypass operation. Even less do they value their GP's work in preventing them from developing heart disease in the first place. What our patients want, as we know from our QOF-driven patient surveys, is immediate access 24/7.
The QOF has made us work harder. My clinic sessions feel far harder and more labour intensive than before the new contract. I believe we earn the money we are paid. I am dismayed that our employer is out to discredit the contract it has foisted on us—and that the media is gunning for the workers rather than the employer.
My solution would be to renegotiate the QOF. Throw out the bathwater, but keep the baby of rewarding performance in areas of evidence based medicine. Throw out the clinical areas that look like they were decided by lobby groups, such as chronic kidney disease and depression. Throw out most of the practice management and allow us to manage ourselves. Finally, make GPs work evenings and weekends. And then leave us alone for 10 years. Please.
Competing interests: IQ is a GP principal in England, enduring and benefiting from the Quality and Outcomes Framework in equal measure.
This article was posted on 5 February as a rapid response to Alan Maynard's article “Is doctors' self interest undermining the National Health Service?” (BMJ 2007;334:234). All the rapid responses to this article can be viewed at www.bmj.com/cgi/eletters/334/7587/234.