Statistics, QOF, fraud and detection in the NHS.

While busily waiting for the next patient to attend during our Party imposed one 10 minute appointment slot suits all, 2.5 hours of booked surgery as opposes to 1 hour of actual of consultation time, we used the down time to trawl the web and found this interesting piece on a BBC News website.

Now if you have a scientific background this makes perfect sense.

If you only have a Harvard or Yale MBA, which all our local PCT managers have, even the cleaners, then you can be sure they understand this excellent piece on how statistics can make you a killer when in fact you are not. For just listen to them act as judge and jury on any topic while they are busy working.

Two examples from general practice illustrate this.

The first involves their policing of the QOF points. QOF stands for neither a Quality nor an Outcomes Framework.

It merely means a box has been ticked on a computer program. You do not need to see any patient, or give any patient any treatment, just tick the box. And, as a result, you, as a GP can get paid. Simples.

So a practice that has average number of QOF points will not incur any investigation even though none of its patients are receiving any treatment but will still get paid.

Now the NHS has “robust” anti fraud policies so that no GP with no qualifications can ever get away with prescribing creosote for toothache – we jest not read down this link towards the bottom and another did the same too read the small print at the bottom. The NHS has some of the finest forensic brains in the fraud busting world which would make CSI seem like rank amateurs for the only bit of a CSI episode they could understand was the adverts.

They employ advanced fraud busting techniques like if you get the top end of QOF points you are bent.

Of course in the same way that the “boffs” in their class at school got 98-99% scores in exams it was because they were “bent” not clever, or when they are grown up good doctors, while the fact your average PCT fraud buster got 40% in their exams was ‘cause the ref weren’t on their side.

If you are in the bottom of QOF scorers you are also bent. For surely you are not looking after patients? This might be the case but there might be another reason for this, for example the patients do not come to clinics.

And indeed this might be a combination of the above factors. A high scoring practice on paper but when you actually start looking at the patient care it is nonexistent?

However if you are in the top of the local QOF points or the bottom ones you are suspect and will receive the third degree.

This is the average PCT fraud busters approach which is similar to those in Whitehall who saw all of those Weapons of Mass Destruction from afar but in fact they saw nothing but they were still there, allegdedly.

This brings us onto the second argument doing the rounds of the thick regarding PCTs and their Harvard MBAs saying that referrals are too high.

Is that the same as saying illness is too high? “Comrade Zhivago you have referred too many cases of TB from your labour camp. Please stop this as we have overspent our TB treatment budget and you are referring above the 5 year plan targets”.

Is a high referring practice a “poor” practice because it refers everything correctly or, is it a “poor” practice because the GPs are crap and can’t manage simple things that better practices could?

Equally is a low referring practice a crap practice because it does not identify and therefore ignores disease and fails to treat it, or, is it a good practice because it treats disease that does not need to be referred to hospital?

Both these instances affect GPs and if you read the link you might start to realize that some things can appear to be real not because they are but they can also occur by chance.

If you think the odds are small then try this one for size. We wrote this piece on Friday night at the Café Michelle after reading it in the afternoon. We were going to proof read it and publish it today expecting no-one else would have spotted the original piece in the link above.

What are the odds of 2 medical bloggers, one a consultant, respect Dr G, the other a GP reading the same article and being prompted to post their thoughts on the same day? Statistical chance or conspiracy? You decide and you can read Dr Grumble’s thoughts on the same item here.

Praise be to the Party whose knowledge of statistics is second only to their knowledge of healthcare and how to run it. We are in such good hands.

PS Seems another medical blogger has read our inspiration for this piece the Witch Doctor. Did all of us have a slow Friday afternoon and “randomly” click on the BBC News website? Cue X-Files music . . .