Tuesday, 10 April 2012

The end of the QOFing year and why we are ashamed to be GPs.

QOFing is the process by which GPs in the United Kingdom who have signed the nGMS contract have a chance to increase their income above and beyond their fixed income determined by an unknown formula called the Carr Hill formula.

So as the QOF year end approaches we suspect that every nGMS GP and their practice staff will be trying to increase their income against a year on year decline due to “fixed” and decreasing Government payments via QOF and Carr Hill. This is in contrast to lawyers who have had their costs for obtaining medical information fixed by law (page 6) since 1998 but they are allowed to charge what they like as they work in a free market.

So at this weekend’s meeting at the infamous CafĂ© Michelle income and the subject of QOFing were discussed in depth as we know we are all about to take a huge hit in income not because we have worked less we know the reverse is the case. Most of our work is about treating real patients with real illnesses while QOFing is about treating Party defined illness and what the Party thinks is “good” medical practice. We have said before that QOF stands for neither Quality nor Outcomes just a mechanism to reduce GP pay.

As we discussed the lows and lows of Party dictated medical practice things like QOF, appraisal and revalidation and the prospect of the coming of CQC one of the team began to point out how low QOF “quality” indicators had become. They drew our attention to the Mental Health Indicators of this year’s QOF and to our own particular circumstances in our part of Northernshire.

Unusually for Northernshire we have an elite PCT staffed by those with Harvard and Yale MBAs and years of high flying corporate experience who out of the goodness of their hearts feel that this should all be brought to bear to improve our little part of Northernshire’s health service to standards enjoyed in the first world.

Furthermore in our patch we have a disproportionate number of our practice in the under fifties age group with almost universal employment in this group.

Now true mental illness occurs in all strata of society so given the above you would think that QOFing would be easy. Have a look at the nGMS Mental Health Indicators for 2011-12 and make your own mind up as to how much of the data being asked for has any relevance to a) any patient with a mental health illness and the treatment of their illness and b) anyone actually treating a patient’s mental illness other than an administrator. Then have a think about how does one go about collecting this patient and doctor useless information?

Most people in the UK with mental illness try to hide it because of the stigma the great British public attaches to it. If you have a broken arm people will happily sign your plaster of Paris pot but if you have a mental illness they will call you “mental” or “nutter” because they do not understand. There is even a TV advert trying to change this type of attitude.

Furthermore there is a recession and therefore pressure on jobs, even in areas with 100% employment, and so employees do not want time off work unless absolutely necessary.

Look at what QOF wants for mental health this year: BMI, alcohol, blood glucose, blood pressure, cholesterol tests and in women a record of a cervical smear (even if they have declined this test previously) all on an almost annual basis.

So you try different strategies letters inviting people in or phone calls and what we have found is that those who have mental illness are physically well and do not want to know. Strange that if you were fit and well in your twenties would you want to know or waste your time having a series of useless tests? After all most people know their height and if you have a set of bathroom scales why go all the way to the doctors to be weighed? How will that make your mental health better?

They are bright enough to realize that all of this information is totally unproductive to them and their healthcare compared with the real care their psychiatrists provide them with. The psychiatrists enable them to work and to raise families. The GP QOF indicators provide nothing other than data for NHS administrators.

Every psychiatrist’s letter we have read includes none of the above QOF indicators (apart from the odd mention of alcohol) so clearly this information is of no real use to those treating our patient’s real illness, their mental illness, as opposed to the Party’s defined “disease”.

After numerous rejections of our offers for QOF dictated “treatment” or “healthcare” together with a fair few abusive phone calls with those with more extreme mental illness who have told us in no uncertain terms where to stick the indicators we have decided to forego QOF retard mental healthcare and stick with what we were trained to do namely treat patients for their real medical conditions.

Not their QOF indicators.

Thus QOF has come to do what it has always wanted to do reduce GP incomes. If you read QOF indicators and their justification you would think there was some medical need for us to do all of QOF but remember that those who provide this “justification” would have in previous generations have told you that smoking and chewing gum improved concentration in airline pilots and so was a good thing.

No doubt the same people will be saying that QOFing, CQC and appraisal all have similar benefits for patients. A delusion is a belief in the absence of reality. A lot of people in medicine are clearly deluded should they be on a QOF mental health register? And what would they do when we invite them to attend for totally unnecessary and completely useless tests?

So after a great deal of thought on this we have to apologize to any patient who has a mental illness for wasting their time. We have to apologize for being GPs who sometimes treat real patients for real illnesses for which we receive no extra payment and for wasting our patients’ time collecting information for administrators. We are also ashamed to have to prostitute ourselves on the altar of p*ss poor medicine in order to earn income called QOF.

Doctors are meant to be responsible people and it is said that all that is needed for evil to succeed is for good men (and women) to do nothing. Medicine is full of loads of good people and you can spot the most godly of these by the number of QOF points they have. Especially in mental health.

Praise be to the Party for stuffing the faces of GPs with gold to provide “quality” care. When it comes to stuffing the faces of GPs with crap medicine to provide substandard patient useless care we take exception.

Is there a QOF code for that?


Anonymous said...

Three cheers ND the voice of reason!
Ex practice nurse, all qofed out.

Anonymous said...

Well, I took your advice from your last post and ignored the stupid letter I received from my Gp practice to attend for a blood pressure review, much to the chagrin of one of the partners when I last saw her regarding an unrelated case.

Anonymous said...

Why not offer the patients a 50% cut of the qof money or does that breach a code of some sort? Or what about being open and saying the government wants you to carry out some irrelevant tests but you'd like the patients to help so that you can get more money for your practice? You could even have one of those fundraising thermometer charts in your waiting room and allocate the money specifically to mental health care.

Personally, I turn up for this sort of thing because my GP's always there for me when I want so I'll be nice in return. Mind you, he's into research stuff too so I do also get tested for some things I consider irrelevant to anything but again it's quid pro quo.