Re: Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012
Dear Editor,
Soljak may be placing too much trust on QOF data generated in primary care.
I responded to the article of Dixon et al with an example graph of the local diabetes prevalence (1). Even though our practice was an extreme outlier for diabetes prevalence in 2004 the local Primary Care Trust never questioned or checked our diagnostic criteria which determine our diabetic register.
If you add a non-diabetic to the register two things happen: Firstly your payments for the whole disease area increase as they are prevalence weighted and secondly your achievement of targets immediately improves, saving you from having to try to treat someone with actual diabetes to target.
Local diabetes prevalence was linked to deprivation but this link has nearly disappeared in the 6 year period covered by the QOF data.
The obesity indicator is payable in full the second a single patient is recorded with a BMI over 30. Not every registered patient attends every year and we only take height and weight if there is a clinical indication. The obesity 'register' of our practice is meaningless.
The introduction of Snomed-CT was promised within 2 years when we changed our clinical system supplier in 2003. However the only coding systems used for the QOF data (QOF business rules) are READ2 and CTV3. (2)The ICD 10 system that may be in use in hospitals is not used for data collection in primary care.
Pay formulae are wholly dependent on the database that was used to develop them. The Technical Steering Committee for the GMS pay formula review found huge shifts in funding depending on the database used to determine patient 'need' adding to existing problems with equitable distribution of resources. (3,4)
The concept of active patients as patients that are registered with a GP may not be valid for determining health need. We frequently register patients that have been in the area for years but never registered. They often present with immediate and neglected health needs. List inflation probably provides some amelioration of funding deficits in areas of high population turnover and simply removing this may not resolve inaccurate allocation of area funding.
Rapid Response:
Re: Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012
Dear Editor,
Soljak may be placing too much trust on QOF data generated in primary care.
I responded to the article of Dixon et al with an example graph of the local diabetes prevalence (1). Even though our practice was an extreme outlier for diabetes prevalence in 2004 the local Primary Care Trust never questioned or checked our diagnostic criteria which determine our diabetic register.
If you add a non-diabetic to the register two things happen: Firstly your payments for the whole disease area increase as they are prevalence weighted and secondly your achievement of targets immediately improves, saving you from having to try to treat someone with actual diabetes to target.
Local diabetes prevalence was linked to deprivation but this link has nearly disappeared in the 6 year period covered by the QOF data.
The obesity indicator is payable in full the second a single patient is recorded with a BMI over 30. Not every registered patient attends every year and we only take height and weight if there is a clinical indication. The obesity 'register' of our practice is meaningless.
The introduction of Snomed-CT was promised within 2 years when we changed our clinical system supplier in 2003. However the only coding systems used for the QOF data (QOF business rules) are READ2 and CTV3. (2)The ICD 10 system that may be in use in hospitals is not used for data collection in primary care.
Pay formulae are wholly dependent on the database that was used to develop them. The Technical Steering Committee for the GMS pay formula review found huge shifts in funding depending on the database used to determine patient 'need' adding to existing problems with equitable distribution of resources. (3,4)
The concept of active patients as patients that are registered with a GP may not be valid for determining health need. We frequently register patients that have been in the area for years but never registered. They often present with immediate and neglected health needs. List inflation probably provides some amelioration of funding deficits in areas of high population turnover and simply removing this may not resolve inaccurate allocation of area funding.
(1) http://www.bmj.com/content/343/bmj.d6608?tab=responses
(2) http://www.pcc.nhs.uk/business-rules-v22.0
(3) http://www.nhsemployers.org/SiteCollectionDocuments/frg_report_final_cd_...
(4) http://www.biomedcentral.com/1472-6963/10/156
Competing interests: No competing interests