I am alarmed that Dr Lewis can write so patronisingly towards a
student colleague. I believe Edward Chandy’s alarm is very far from
misplaced. To say that QOF is worth a substantial proportion of practice
income on the one hand and also say that QOF is voluntary and that no
doctor is forced to participate is being slippery to say the least. Please
consider the junior partner or the salaried GP and the pressure to conform
to QOF for the financial health of a practice.
The proposed new targets in diabetes are a potential source of
conflict. As another example of conflict, consider coronary heart disease
(CHD) and the controversial cholesterol hypothesis: some doctors believe
that the relationship between the cholesterol level and the development of
CHD is tenuous and that artificially lowering the level may actually be
harmful. A paper published in the BMJ (2007) revealed that in women at
least, there was no mortality benefit in taking cholesterol lowering
drugs, despite their enormous cost and morbidity inducing potential. [1]
And yet the QOF incentivises the measurement of cholesterol and the
cholesterol lowering achievements of the practice. In effect the QOF
coerces some doctors to measure cholesterols and prescribe the statin
drugs against their evidence-backed judgement. The situation is alarming
and Edward Chandy is absolutely right to raise it.
Rapid Response:
Re: Re: Ethics of QOF
I am alarmed that Dr Lewis can write so patronisingly towards a
student colleague. I believe Edward Chandy’s alarm is very far from
misplaced. To say that QOF is worth a substantial proportion of practice
income on the one hand and also say that QOF is voluntary and that no
doctor is forced to participate is being slippery to say the least. Please
consider the junior partner or the salaried GP and the pressure to conform
to QOF for the financial health of a practice.
The proposed new targets in diabetes are a potential source of
conflict. As another example of conflict, consider coronary heart disease
(CHD) and the controversial cholesterol hypothesis: some doctors believe
that the relationship between the cholesterol level and the development of
CHD is tenuous and that artificially lowering the level may actually be
harmful. A paper published in the BMJ (2007) revealed that in women at
least, there was no mortality benefit in taking cholesterol lowering
drugs, despite their enormous cost and morbidity inducing potential. [1]
And yet the QOF incentivises the measurement of cholesterol and the
cholesterol lowering achievements of the practice. In effect the QOF
coerces some doctors to measure cholesterols and prescribe the statin
drugs against their evidence-backed judgement. The situation is alarming
and Edward Chandy is absolutely right to raise it.
[1] Malcolm Kendrick. Should women be offered cholesterol lowering
drugs to prevent cardiovascular disease? No. BMJ 2007; 334: 983.
http://www.bmj.com/cgi/content/full/334/7601/983
Competing interests:
None declared
Competing interests: No competing interests