Sunday, 13 February 2011

QOF ain’t working.

One of ZaNu Labour’s great misconceptions about GPs is that all of us are idle and not treating any patients. As part of the increasing centralization and Sovietization of NHS healthcare, ZaNu Labour introduced the concept of tick box medicine into General Practice via the Quality and Outcome’s Framework known as QOF.

GPs who work under the new General Medical Services (nGMS) contract receive most of their income from a global sum calculated via the Carr Hill formula, which nobody knows what the actual formula is, under the opacity of transparent government and from QOF points which is a performance related pay scheme. Tick certain centrally determined boxes and you get extra money. Don’t tick them and you don’t get money.

When QOF was introduced ZaNu Labour fully expected GPs to only achieve 6-700 out of the original 1050 points available. Most GPs in the first year got to close to 1000 points which upset Tony and Gordon for they then had to pay GPs something which is an alien concept here in the UK where healthcare is free in contrast to poorly paid lawyers like Tony and his wife Cherie.

Not being spiteful or vindictive in any way the Party shifted the goal posts, reduced the number of points in order to pay GPs less and so cut GPs pay while making them worker harder to achieve the same income. There is an expression in the UK that points mean prizes and they do to GPs as they make up part of their pay.

Now QOF is neither Quality medicine nor real Outcomes. It is possible to achieve high QOF points without seeing any patients at all. As long as information is on a hard drive on the 31st March each year you get paid. How that information gets there is immaterial.

Performance related pay is often thought to increase productivity but a little piece in the British Medical Journal looked at the effect that QOF had had on high blood pressure and came to the conclusion that it had had no effect on quality or outcomes. For those not interested in learned journals a more informed piece about this is here.

So here is a big thank to all those practices that have redesigned how their receptionists, practice nurses, practice managers, GPs have worked to deliver the central imposed Soviet style QOF tick box dumbed down medicine.

If you have been invited to come and have your blood pressure checked by your caring GP, then had a load of other tests which have cost you time for no benefit you will be pleased to know that it may be the result of QOF.

And it hasn’t made any difference. A complete waste of time and money to tick boxes.

The research makes the point that UK General Practice was actually delivering the goods BEFORE QOF appeared and DESPITE Gordon and Tony tinkering with (or is it buggered up?) the NHS.

Furthermore medicine is a dynamic discipline and new research and new advances mean that QOF is frequently out of date and sometimes dangerous to patients. Does a good doctor ignore outdated QOF criteria and treat to modern medical standards and forego income or does he conform to outdated Party tick box medicine to maintain income and thereby compromise good patient care?

Praise be to the Party for maintaining high modern medical standards via targets and tick boxes. He who pays the piper plays the tune and when QOF pays who suffers? The patient medically by the doctor conforming to QOF or the doctor financially by not conforming to QOF and delivering up to date medicine by treating patients properly.

Looks like no-one wins from QOFing but at this time of year we bet a lot of GPs will be doing it.


Anonymous said...

It always amuses me that whenever I have to see a different GP at the practice to my normal guy, the other chap insists on doing the PHQ-9 every single time. I believe it's a QOF measure and it is the most pointless thing ever. Why bother asking me 9 useless questions about whether or not I am depressed when he already knows the answer. If the appointment is filled with the ticky box exercise he has less time to actually assess how I'm doing. I do think it over estimates the severity quite a lot too as even when I have considered myself fairly well my score is still usually at least "moderate".

My normal GP has never bothered to waste our time with it, which is a relief.

pj said...

Haha. The PHQ-9. GPs keep putting this score on the referral letters we get in secondary care but we can completely ignore it (well, some people say a full score on the PHQ-9 is indicative of personality disorder).

When I worked in General Practice we all knew the PHQ-9 was nonsense but you've got to fill it in at diagnosis and then within some arbitrary time frame (12 weeks?). The danger is if you rely on that rather than the proper mental state assessment that we used in the old days.

Northern Doc said...

Thank you for reading and taking the trouble to post your comments. A lot of us at ND Central do not do PHQ9s but this creates a headache for the local Soviet as they apply the old witchfinder’s system of justice to general practice. If you float you are a witch and then burnt and if you sink (and drown) you are innocent.

If you treat without a PHQ9 and code it as depression you lose money. If you don’t code it as depression and don’t do a PHQ9 then your prevalence of depression falls and you are guilty of not treating those with depression when in fact you are. To a PCT witchfinder treatment only occurs when it is coded correctly not when patients get better as a result of not coding and ticking boxes. Curious that?

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