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.
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Northern Doc was once a blog originally written by a group of GPs in Northernshire and expressed their experiences and frustrations of working in today's NHS. The pieces were compiled at social meetings after work and published anonymously in a once free society. Following the Government's Medical Council clamp down on freedom of thought, speech and expression by doctors and our belief that the views of a few doctors DO NOT represent the views of the profession as a whole their views will now be written by and published by a journalist who has previously contributed to the blog by virtue of social ties. Any inference that the word Doc means a doctor is now purely coincidental. This is as of the 22 April 2013.