Intended for healthcare professionals

Editor's Choice

A good QOFfing whine

BMJ 2008; 337 doi: (Published 20 November 2008) Cite this as: BMJ 2008;337:a2632
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}

    In this week’s BMJ we report a study attributing improvements in blood pressure monitoring and control in patients in English general practices to the quality and outcomes framework (QOF; doi:10.1136/bmj.a2030). Intriguingly, the improvements were accompanied “by the near disappearance of the achievement gap between least and most deprived areas.” For editorialist Helen Lester, “This offers the tantalising prospect that the quality and outcomes framework is a truly equitable public health intervention”—and there aren’t a lot of these (doi:10.1136/bmj.a2095).

    QOF has many detractors, and their criticisms are well summarised in the new report, Checking-Up On Doctors ( Perhaps the most damning is that doctors turn their attention to condition whose treatments bring financial rewards, while ignoring those without dowries.

    Our general practitioner columnist Des Spence is underwhelmed by soft surrogate markers of disease reported in these articles (doi:10.1136/bmj.a2619). He wants hard endpoints: vascular deaths and unambiguous complications. Yet his ending is cosily familiar: “Our energy has been spent bean counting the measureable while dismissing the most valuable aspect of medical care, the immeasureable.”

    Immeasureable, ineffable, hid from our eyes… In the current financial and political climate is it wise to defend primary care solely by invoking its warm fuzzy heart, beating away in its black box, far from the close scrutiny of all but its adepts?

    Elsewhere this week’s journal reminds me of Mary Russell’s wonderfully titled book: The Blessings Of A Good Thick Skirt: Women Travellers And Their World. We have dispatches from three intrepid women travellers: Tessa Richards in Washington DC; Kate Adams in Harare, Zimbabwe; and BMJ editor Fiona Godlee, in Bamako, Mali.

    In what for the moment is that shining city upon a hill, Richards notes the ubiquity of Obama merchandise, much of it emblazoned with the words “change” and “hope” ( Should she buy a fridge magnet or a T shirt? At a meeting she learns that the best investment in global health is to train researchers in low income countries and link them to the global, medical, scientific, and public health community (doi:10.1136/bmj.a2620). An exhibition promotes the idea that “global health depends on providing all people, in all countries, with food and clean water, health information, and access to affordable health care.” It enshrines the message “that health should be seen as a human right—and protected as such.”

    Try to read Kate Adams’ account of her visit to Zimbabwe immediately after this and not be moved—and then outraged—by the flouting of each of these principles (doi:10.1136/bmj.a2637). Adults are being admitted to hospital with malnutrition; wards are half empty because patients can’t afford the cost of transport and drugs. Hospitals have run out of soap, antibiotics, and gloves. Harare’s main hospital has now closed its doors to new admissions. “The health system is in a state of collapse,” despairs Adams.

    Five thousand kilometres to the north west, the Global Ministerial Forum on Research for Health is meeting in Mali. As Godlee describes in her blog ( the aim is to come up with a call for action to strengthen research for health in developing countries. Dodging the traffic on Bamako’s hectic streets is almost as difficult as dodging the health policy jargon in the conference hall, she says. But the expense of getting so many key people together in one of the world’s poorest countries should shame them into producing something concrete.

    Douglas Kamerow celebrates the short but incredibly productive life of Ron Davis—first editor of the BMJ Group’s Tobacco Control, one time North American editor of the BMJ, and first editor of BMJ USA, a monthly BMJ digest circulated to 100 000 US doctors (doi:10.1136/bmj.a2643). More recently, he was the 162nd president of the American Medical Association. Kamerow’s obituary makes it clear why we were so lucky to have him.


    Cite this as: BMJ 2008;337:a2632

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