Detecting Atrial Fibrillation in general practice - the hidden price
One year ago, I became a principal in general practice. In
partnership with another general practitioner, I took over a large single
handed practice with a significant elderly population. The findings of
this study are most relevant to a population such as ours, where improved
recognition of Atrial Fibrillation is likely to lead to the great
improvements in outcome. Such screening would inevitably become a part of
the Quality and Outcomes Framework (QOF), which is based on the axiom that
increased screening is a pre-requisite for improvements in health care in
primary care. For a large number of indicators within the QOF, practices
must screen all patients in a particular group for indicators of disease,
and then treat according to guidelines to achieve changes in health risk
status (Department of Health, 2007). However, every time a new indicator
is added to the framework, such as annual electrocardiograms for all
patients over 65 years old, this has significant workload and associated
cost implications for the practice. The QOF may link increased income with
such a screening programme but it is likely to come from other areas and
care is still expected to remain at its previous high level in the areas
from which the funds are removed. Consequently, primary care staff must
find the extra time using existing resources.
Diverting time and energy to taking electrocardiograms will result in
another aspect of healthcare having reduced time spent in that area. The
group of patients who benefit from screening electrocardiograms are also
the same group that suffers from coronary heart disease, chronic
obstructive pulmonary disease, chronic kidney disease and depression. They
require time spent on these areas too. In practice, the QOF has already
reduced the time available to listen to patients’ concerns, explain the
nature and implications of their illnesses to them and to address their
immediate worries. For Balint, the health professional is the drug
(Ballint, 2000), and Pendleton et al believe that it is important to spend
time reaching a shared understanding of illness (Pendleton et al., 2003).
Even Neighbour’s five key tasks included a process of negotiation
(Neighbour, 1994), which is now at risk. My worry is that these aspects of
the consultation will be lost as we strive to introduce more and more
screening procedures and targeted care into the primary care consultation.
NEIGHBOUR, R. (1994) The Inner Consultation: How to Develop an Effective
and Intuitive Consulting Style, Norwell, USA, Kluwer Academic Pubishers.
PENDLETON, D., SCHOFIELD, T., HAVELOCK, P. & TATE, P. (2003) The New
Consultation : Developing Doctor-Patient Communication, Oxford, Oxford
University Press.
Competing interests:
None declared
Competing interests:
No competing interests
09 August 2007
Andrew M Thornett
Senior Clinical Lecturer in Medical Education & General Practitioner
Faculty of Health, Staffordshire University, Blackheath Lane, Stafford, ST18 0AD
Rapid Response:
Detecting Atrial Fibrillation in general practice - the hidden price
One year ago, I became a principal in general practice. In
partnership with another general practitioner, I took over a large single
handed practice with a significant elderly population. The findings of
this study are most relevant to a population such as ours, where improved
recognition of Atrial Fibrillation is likely to lead to the great
improvements in outcome. Such screening would inevitably become a part of
the Quality and Outcomes Framework (QOF), which is based on the axiom that
increased screening is a pre-requisite for improvements in health care in
primary care. For a large number of indicators within the QOF, practices
must screen all patients in a particular group for indicators of disease,
and then treat according to guidelines to achieve changes in health risk
status (Department of Health, 2007). However, every time a new indicator
is added to the framework, such as annual electrocardiograms for all
patients over 65 years old, this has significant workload and associated
cost implications for the practice. The QOF may link increased income with
such a screening programme but it is likely to come from other areas and
care is still expected to remain at its previous high level in the areas
from which the funds are removed. Consequently, primary care staff must
find the extra time using existing resources.
Diverting time and energy to taking electrocardiograms will result in
another aspect of healthcare having reduced time spent in that area. The
group of patients who benefit from screening electrocardiograms are also
the same group that suffers from coronary heart disease, chronic
obstructive pulmonary disease, chronic kidney disease and depression. They
require time spent on these areas too. In practice, the QOF has already
reduced the time available to listen to patients’ concerns, explain the
nature and implications of their illnesses to them and to address their
immediate worries. For Balint, the health professional is the drug
(Ballint, 2000), and Pendleton et al believe that it is important to spend
time reaching a shared understanding of illness (Pendleton et al., 2003).
Even Neighbour’s five key tasks included a process of negotiation
(Neighbour, 1994), which is now at risk. My worry is that these aspects of
the consultation will be lost as we strive to introduce more and more
screening procedures and targeted care into the primary care consultation.
BALLINT, M. (2000) The doctor, his patient and the illness, London,
Elsevier Health Sciences.
Department of Health (2007) Updated version of original QOF guidance and
evidence base.
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Primarycare...
[accessed 9/7/08].
NEIGHBOUR, R. (1994) The Inner Consultation: How to Develop an Effective
and Intuitive Consulting Style, Norwell, USA, Kluwer Academic Pubishers.
PENDLETON, D., SCHOFIELD, T., HAVELOCK, P. & TATE, P. (2003) The New
Consultation : Developing Doctor-Patient Communication, Oxford, Oxford
University Press.
Competing interests:
None declared
Competing interests: No competing interests