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Beyond measure

In 2003, as final details of the contract were thrashed out, the negotiators were adamant the QOF would be a voluntary exercise. Some GPs, they insisted, would choose only to chase 100 points or so. There was no question of it being used as a performance management tool.

In 2003, as final details of the contract were thrashed out, the negotiators were adamant the QOF would be a voluntary exercise. Some GPs, they insisted, would choose only to chase 100 points or so. There was no question of it being used as a performance management tool.

Those statements now seem almost touchingly naive. The QOF is a grand experiment in clinical care, which has produced one of the largest primary care datasets the world has ever seen.

It was asking a lot to imagine cash-strapped PCTs and enthusiastic prescribing advisers would resist the temptation to use that data for performance management.

Abuse of GPs' trust

Heart of Birmingham PCT was among the first to abuse GPs' trust, scandalously naming and shaming those it saw as poor performers.

Now we learn PCTs are taking a subtly different tack, combining QOF prevalence data with prescribing stats to create a new hybrid management tool.

But among the management madness, a couple of academic studies provide some clarity. Research in the BMJ finds QOF points have little relation to an objective measure of clinical care. Last week a study found assessing GPs on referral rates was also invalid. We already know judging GPs on prescribing stats is similarly flawed.

Managers love things they can measure. Here is something they will hate. Quality patient care is often intangible. There's a danger that in forever seeking to measure, we will destroy.

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