Posted by: Tony Copperfield1 October 2012
QP12. No, come back. Look, if we didn’t have the misfortune to be GPs, a QP12 could be a recipe album, a World War II shipping convoy or a lead acid battery (cheers, Google). But we are, and it isn’t. It’s one of the revised quality and productivity hoops – raised higher, doused in petrol, then set on fire – that we’re supposed to jump through.
Except that, according to recent reports, many of us aren’t. So the plan to slash A&E attendances has gone phut, perhaps because we missed the tight deadline, or the PCT failed to provide the relevant data, or we just couldn’t be arsed.
Given the potential domino effect on QP13 and QP14, this could be a complete QOFtastrophe. But that’s not the main reason why QP12 has got right up our turbinates.
What’s really annoying is that this QP criterion is an implied criticism of our practices. Oh, hang on. No it’s not. It’s an explicit criticism of our practices.
There it is, in finger-wagging black and white: ‘The practice will meet internally to review data on A&E attendance ... the review will include consideration of whether access to clinicians in practice is appropriate in the light of the patterns.’ Or, as Malcolm Tucker would say: ‘You’re shite and you know you are.’
Thanks for that. Where the QOF was once a motivational tool, it now reads more like a Daily Mail editorial.
Listen, QPeople. My practice has repeatedly looked at A&E ‘abusers’, and the message is consistent. They roll up to casualty not because we’re shut, unapproachable, lacking appointments, inflexible, uninterested, or any other access cliché you care to trot out. No, they go either because they live nearer to A&E than they do to the practice, or because they want antibiotics and they know that, while we won’t dish them out, the casualty officer will. Oh, and because they abuse every other service, too.
Logically, our proposals for QP13 and 14 should be to dismantle the health centre and rebuild it next to A&E, and/or put a massive trough of amoxicillin in our waiting room/and or cull frequent attenders. Lack of premises investment and draconian prescribing restrictions means only one of these is realistic.
We can hardly blame the punters, though: they’ve been force-fed a message of choice in healthcare, so no wonder they choose where and how to have their ‘accident’ or ‘emergency’ dealt with. Nor can we blame casualty – after all, it’s in their interests to attract custom, even if it does mean erecting a flashing neon ‘McDoxycycline’ sign.
So that leaves us. Inappropriate A&E attendance is our fault, even though it isn’t, and it’s up to us to sort it out, even though we can’t. And when we’ve finished banging our head against this particular wall, presumably we can look forward to more cranial trauma – with, say, new QP criteria browbeating us into reducing other politically driven, uncontrollable workload, such as out-of-hours calls or two-week referrals. All of which will be enough to give us subdurals.
Off to A&E? Er, no, it’ll spoil our figures. Besides, the way things are going, I’d rather let nature take its course.
Dr Tony Copperfieldis a GP in Essex