Tuesday, 17 January 2012

Less is the new more. Practical QraPing vs patient care.

In contrast to politicians who litter their speeches with their constant encounters with the vox populi your average Ferrari owning GP living in their baronial mansion house who daily is on the golf course would never see a patient in their life, if you believed the politicians. Hence their constant need to bugger up things that work via reform (the politicians that is).

We bet if one such GP said that patients would prefer to see their GPs in a surgery rather than have their GPs sitting in meetings looking at pretty, pretty graphs the politician would tell them where to get off and set a once a week GP on a future forum to put such a devient GP in their place.

A recent meeting and a series of conversations with GPs from other practices shows how central Party control is taking more GPs further away from patient care in order to direct them towards tri Party care aka commissioning. We return once again to the QraP (QP indicators = Quality and Productivity) indicators of the useless QOF (Quality and Outcomes Framework) of the nGMS (new Genral Medical Services) contract.

QraP is nothing more than Party approved love ins and huge group hugs to ensure that all GPs are equally dumb, Party dumb, deny patients care dumb to save managers money by not treating patients dumb. We have posted before on this but the slow onset of terminal buttock ischaemia from sitting on our arses in (medically) useless meetings is starting to affect our sanitity.

We return to the QraP indicators and will concentrate on QraP indicator 6 which can be found with the rest here. Once again GPs who are trained to work as professionals on an autonomous basis are now being subjected to an increasing collective centralized censure to ensure that all referrals are now collective decisions, not individual decisions made by an autonomous trained professional, leading to socialized medicine which to our limited minds smacks of the former communist model so loved in the former Easten Bloc (deceased) and still practised in the North Korea with its obvious benefits to patients there.

A recent meeting in order to achieve the net outcome of this process, a series of pro formas filled in and sent back to the local Soviet for them to approve, tick the box and authorize payment for GPs not to treat patients was an eye opener as to how low Brown/Blair/Cameron/Clegg/Lansley Party control has become in denying our patients real medical care.

Remember all of the above are fully trained medical professionals, public school educated, extremely privilaged people who have never worked in the NHS and so can speak with the same authority as a brothel owner on the benefits of virginity in increasing sexually transmitted disease and the birth rate via the private sector.

The QraP 6 indicator is as follows:

The practice meets internally to review the data on secondary care outpatient referrals provided by the PCO (Primary Care Organization aka local Soviet).

(italics are our counter revolutionary ones must stop watching Dr Zhivago).

Well for starters the information provided by the local Soviet was worse than useless. Lots and lots of pretty, pretty graphs and numbers in all sorts of colours they had found while pretending to understand Excel. If they had had to try and draw and label any of these graphs by hand on graph paper by themselves for their teacher at school they would have put them in detention for not producing anything readable. Oodles and oodles of pretty, pretty piles of paper going to a landfill site at the detriment of real patient care and in doing so achieving nothing towards real patient care.

When we had deciphered, or thought we had we had to guess what all the initials meant, we then followed the PCO’s pro fromas as to what we had to do and fill in. People who had failed in everything they did at school continue to do so as more and more of the data turned out to be at complete variance with the practice’s more accurate computer data. We found referrals we had made which we hadn’t and referrals we had that hadn’t resulted in patient care until the second or third request that had generated hospital income at the expense of real patient care.

We reviewed our referrals and collectively (see we are actually “team” players) agreed all were appropriate. We have done this pointless exercise numerous times before for NHS managers who are all better doctors than we are for some of them can count but only up to the number of fingers on their hands that they are not sucking in their mouths or stuck up some other dark orifice doing nothing useful.

Each time we have found that we could not prevent referrals and each time the concensus is that with hindsight we should have referred to a more expensive service to better serve our patients’ healthcare needs which is at odds with this exercise which is to save the muppets in PCO land money.

At the end of this completely useless exercise several pieces of paper were filled in and a  grand total of 8 days of GP time had been wasted to achieve what?

16 pages of A4 paper pro fromas filled in to achieve 6 QOF points at £130.51 per point for an average practice. This income would not even cover the cost of a locum to replace the lost doctor boots on the ground treating real patient in real time. It certainly did not replace the 8 full days of appointments lost for patient care and this is set to get worse under the Tripartite health policies being persued at present.

Praise be to the Party for giving us QraP 6 to deny patients’ care by removing doctors from treating them. QraP 7 is even better socialized medicine. How many more surgeries will have to be disabled to ensure that QuaP 7 succeeds?

Has anyone noticed the subtle subtext that QraPing is grooming GPs to become fundholders sorry clinical commissioners via clinical commissioning groups?

It is not big it is not clever and doctors should be using their time to treat patients. Not prop up a hugely flawed and failed idea called commisioning. When will the politicians wake up and see that they all are providing everyone with is less and costing more to do so?


Single Female Doc said...

I always find internal meetings with myself (I being all the pratners) quite frustrating, as my multiple personalities never seem to get on.

Anonymous said...

Being set up to fail. springs to mind. All keen CCG leads having egos massaged by attending BIG important meetings LOL. Mantra save save .. Meantime FT's aint gonna give up income streams easily whilst they pay off their PFI loans.. complicated Kafkaesque tarifs constantly out witting redesign of clinical pathways .It was all the elements of a perfect storm.. and GP's are gonna be the fall guys when the money runs out..hey ho.