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Margaret McCartney: Pointless paperwork, not patients, is what GPs should avoid

BMJ 2017; 359 doi: (Published 06 November 2017) Cite this as: BMJ 2017;359:j4933

Re: Margaret McCartney: Pointless paperwork, not patients, is what GPs should avoid

The term "quality improvement" has become a trend-word that leaders use to back up their ideas for change. Who can argue against wanting improvement?

But the proof is in the pudding: do our modern attempts at "quality" achieve their aim? Or, as you are pointing out, do they simply increase the paperwork, pass the buck, lay the responsibility at the feet of the wrong people, and give the appearance that problems are dealt with efficiently?

Put in clinical terms, this type of management is the equivalent of a doctor treating a case of a febrile headache by demanding more temperature measurements, proposing a psychology referral to define whether it really is a headache, offering counseling to the clinician on time-management and prescribing the cheapest treatment that achieves the cure of the symptoms: paracetamol. And meanwhile, the patient dies of meningococcal meningitis. All the "quality improvement" initiatives accomplished, but none that relate to what the patient really needs!

Quality improvement has come to mean "protect the system", "eradicate error", "hit the target", "save money"; its last priority being to "satisfy the patient" by enabling the medical staff to perform what they have been trained for. If we agree with the views of the author, then reduction of pointless paperwork would be helpful in this regard. But who has the authority to make this happen and who should perform it? Managers: who in turn need to be given the time and support to plan and coordinate the "pointless paperwork reduction strategy", do the changes, study the results and act to adjust the inputs if they were insufficient. It will doubtless be a long journey, but will require little investment and bring long term benefits.

Carried out with this purpose and in this way, the term "quality improvement" would cease to be treated with derision by clinicians, and might instead fulfil its dictionary definition.

Competing interests: No competing interests

07 November 2017
Peter Campbell
Independent Public Health Consultant