Where do I start! QOF was introduced with no evidence base, and has had no effect on outcomes according to the experts.
It has increased workload massively and led to massive increases in expensive and dangerous polypharmacy mostly advised by Noctors who are not trained in pharmacology or EBM.
It has led to a breakdown in trust between doctors and patients due to the conflicts of interest involved, and along with the CQC it has pushed many good GPs into early retirement.
According to the latest European comparisons see the recent BMJ, we are now no 16 out of 35 in health care quality with one of the worst records on access, below Macedonia!
If we are happy with that , then retain QOF.
Old news. First of all it’s 4 year old data. Then the price differences are tiny, under 2percent for ACEIs, and less for PPIs. The Sartan data is skewed by the poor availability of Valsartan.
And of course there are a small number of dispensing doctors who do let their financial interest bias their prescribing, but to smear 1in 8 GPs on the basis of aggregated data is unfair just as it is unfair to accuse pharmacists in general of being biased in advising patients to buy useless and expensive remedies for coughs etc because some of them do that.
Could Dr Goldacre and colleagues also do a comparison of patient satisfaction scores, continuity of care, and unnecessary admission rates between dispensing and non dispensing doctors. No prizes for guessing the results.
My dad would turn in his grave. What a stupid idea. Practices should only take on the number of patients they can cope with and then accept the duty to deal with them.
Top tip. Open access turn up and wait surgeries provide a good service, make patients happy, and discourage time wasters.
Second top tip. Continuity
It seems that the guys in charge are determined to implement new ideas that are demonstrably inefficient.
Are other countries doing this? No they are not. I wonder why?
We all have a choice. We can close lists employ locums, reduce practice areas, etc. We don’t do it because we are greedy. The result is bad quality care by rushed doctors, and incompetent Noctors.
And the exceptional practices that have good doctor patient ratios and don’t overprescribe or over refer get no appreciation from on high. After all they expose the uncomfortable truth that it’s the practice that counts, not federations networks CCGs area teams etc etc
It is crazy that we are allowed to prescribe these drugs when you see the abuse and harm we are causing.
Make them all specialist only. End of problem.
Didn’t the recent study and the Cochrane review agree that treating high bp under 160/100 does not reduce mortality but does cause falls AKI etc etc.
Public health is not our job
We have plenty of sick patients.
There is a very obvious answer which is in widespread use. Open access just turn up and wait surgeries for acute problems. Watch your patient satisfaction results shoot up, save lots of money spent on paying re eptionists to say no. Know that your patients acute problems can be treated promptly and sleep well at night.
We used to do this in my former practice but had to stop it on the orders of the NHS area team!
Dear Mr Hancock,
You are right about the problem, that we need better IT, but you are so wrong about the solution.
The main issue GPs face is pathetic bandwidth due mainly to the crap and expensive deal offered by BT which is simply not fast enough to run IT systems with remote servers. Apart from that GP IT is ok though personally I find that very few systemone practices have adequate summaries.
GP IT was world leading when it started in the late 1980’s due to a few bright guys and GPs making informed choices which made EMIS the most popular system. In contrast centrally mandated systems like GPASS were a failure.
You do not need to make all doctors use one system, what you need is interoperability and choice, and a massive effort on broadband.
And by the way, it’s hosptals where IT really is a disaster.
Calling 999 is now an unpleasant experience. Recently I had a patient with a suspected AAA. I was given the third degree by the ambulance control who made me repeat that the patient was conscious and breathing twice and got very cross when I said I was not going to stay with the patient. They said they would be 4 hours! I responded ok if you really want a complaint and an expensive lawsuit and probably disciplinary action.
The ambulance arrived 10 minutes later. But why does I t have to be so difficult?
Noctor is a very apt word to describe people who are trying to do a gps job while lacking the knowledge and skills. The uk is about the only country in the world that is allowing non doctors to treat untriaged patients including prescribing for them. Pharmacists don’t have any training in diagnosis and nurses have no training in medicine or pharmacology. I have seen numerous examples of gross errors that don’t seem even to cause much reflection. Examples include shingles diagnosed as dry skin, HSP on the leg as impetigo, SCC on the lip treated repeatedly with betnovate, erythema nodosum diagnosed in December as ‘bites’etc etc . And as for musculoskeletal.... .. Obviously doctors get it wrong too sometimes but unsupported Noctors (sorry but what other word can I use ) are not up to the job and the really bad thing is that some of them don’t seem to know it.
Nurses are excellent with chronic patients if they are well trained and have easy access to doctors. But in the uk we are making a terrible mistake using non doctors in doctor roles without conducting any formal evaluation. No other country in Europe is doing this. We aren’t doing nurses or pharmacists any favours asking them to work above their pay grade. And no I am not going to do a bit of neurosurgery!
The only solace for you in this horrible and unfair situation is that you have united our profession in our contempt for our regulators. You are a very brave woman and they don’t deserve to wash your feet. Hold your head high and hang in there. We are rooting for you.
‘GPs conduct regular medication reviews...’ says our in touch college chair. On which planet is that?
If your Gp workforce has gone down by 30-50 percent as it has in many practices, and the number of drugs recommended by an army of specialists just keeps rising exponentially you just give up.
We need to have all patients pay for prescriptions so they ask awkward questions, and educate specialists about polypharmacy until they at least consider sometimes stopping a drug! And sorry most pharmacists are just too ignorant of medicine to do this job well.
The battle for free speech and liberty equality fraternity is not yet won. Oppressive regulators like the CQC GMC will use weasel words like ‘lack of insight’ and ‘offensive and ... inappropriate’ to try to close down critics of the stultifying humourless dull box ticking pointless pile of s**t that they peddle and have the cheek to demand our money for.
CQC staff (who are basically failed NHS managers) spend one yes’s that is 1 day per week doing inspections and the rest of the week having coffees and outings and reporting hard working doctors to the GMC
What do they think this does for morale among GPs, who are in desperately short supply in large parts of the country, but that’s not their problem is it? .
God help England - I am moving.
Good for you Hendrik, for standing up to these w*****s. Presumably you have an escape route too. Fair enough.
So this guy is good at running the CQC whose assessments of practices according to recent research from Manchester university show no correlation with any other data on patient satisfaction, or other quality measures and whose attempts to close small practices down have consistently been successfully appealed.
So his reward for this expensive way of achieving exactly zero is to move to HEE which is the quango that keeps messing up the training of juniors like Chris Day. They removed him from his training programme, but when he took them to an employment tribunal they had to be dragged there kicking and screaming after spending loads of taxpayers dosh on lawyers saying they weren’t an employer!
But you don’t have to actually do anything to ‘succeed’ in this country, just brown nose your way to the top and when the s**t starts to hit the fan you just move on to the next ‘job’
Do you need a medical degree to be a psychiatrist? In my experience many of them don’t seem to understand physiology or pharmacology or the rules on giving drugs for conditions they are licensed for. I worked in rural Africa where mentally sick patients were treated by witch doctors and on balance the results seemed better there.
But hey the GMC and revalidators have got egg on their face yet again. Not that that will spoil their lunches just yet. . Come on Martin Luther
"Send me their addresses" - dont make me laugh. BT have got millions per year for 15years for providing sweet FA and calling it BT N3. They know exactly what s**t they are supplying to whom.
What we don't know is to who and how much was paid in sweeteners to enable them to get the contract in the first place.
Wouldn’t it be great if noctors were not being encouraged to do stuff above their pay grade and hence make silly mistakes like this that cause work and waste everyone’s time including their own.
Then we wouldn’t have to complain and upset people.
The uk is the only country trying this noctor experiment. In my view it’s an expensive way of getting really poor quality care and it needs scrapping as soon as we can.
If we used cheap i.e. non Human insulin and metformin and gliclazide (and low carb diets) and binned all the other useless gliptiins etc which make no difference to outcomes them the cost would go down to maybe 10% of the current sum.
Electronic referrals can work without tick box forms. The former are quick and efficient the latter are an insult to our professional skills.
Where are the RCGP and the BMA on this ?
What patronising rubbish. If we lecture patients and demonstrate that we don’t respect them we damage our relationship and make them less likely to present with important symptoms
.Also Numerous trials have failed to show benefit from unrequested advice.
And he is saying this in the context of a drastic doctor shortage in which patients real medical needs are not being met.
Obesity is a social issue and it is society that needs to change.