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At the heart of general practice since 1960

Confusion on mental health referrals

I was disturbed to read the story about the Heart of Birmingham Teaching PCT naming and shaming GPs who had

scored below 750 QOF points (News, June 18).

Ensuring patients have quality care is vital so there may have been some justification if there was evidence to suggest that such a score was a sign of poor practice, but there isn't.

Furthermore, if practices with similar numbers of deprived and ethnic minority patients and similar historic levels of staffing and funding were compared

there would be some fairness in the process.

However, there appears to have been no such care taken before publishing the figures and some practices were penalised for IT faults that failed to collate the points accurately.

The most disturbing aspect of this shoddy affair is that six out of the eight names on the list were suggestive of doctors originating from the Indian subcontinent. Such GPs have often worked in deprived areas and have been resourced poorly.

If the process applied by the PCT unfairly discriminates against them there may be a case for reporting the PCT to the Commission for Racial Equality. For example, part-time workers were deemed to have the same rights as full-time workers since the former are more likely to be female and it was argued that different rights could be a case of sex discrimination.

Similarly, this PCT's actions, which by its own admission were 'crude, arbitrary and unvalidated', may have discriminated against GPs of overseas origin.

I would urge the GPC and the British International Doctors Association to look into this matter carefully and consider reporting the PCT and the relevant members of staff to the Commission for Racial Equality.

Dr Kaiser Chaudhri

Preston

I was interested to read that low-scoring GPs had lost the right to 'light-touch monitoring' in Birmingham (News, June 18).

This suggests the quality framework is an exact science, yet this year's QOF visits were light touch, so how does anyone know whether these GPs were really low scoring or simply very honest within a 'light touch' environment?

There are certainly differences between practices on the use of exemptions, for example, but I'm not aware of any standardisation to penalise those where

this facility has been used with overenthusiasm, although this can skew

the score.

In an honest society that displays natural justice, surely no one can have the ultimate right to a light touch without having being carefully monitored to a more standardised package first of all?

In the Birmingham SHA results I understand there was a correlation between effectiveness of computerisation in a practice and QOF results, with big practices tending to do better.

As a basic minimum, someone should be looking at supporting these doctors if there are issues around IT and computerisation which they cannot themselves sort out, rather than making an example to the media for whatever ultimate motive.

Dr B Bedford

Hythe

Hampshire

It is a shame Dr Snell and the SHA have chosen to vilify individual GPs instead of doing something constructive with the data (News, June 18).

He is in a privileged position of having access to the most exciting data on general practice in decades. Instead of doing statistical analysis and publishing results in a peer-reviewed journal he has chosen this shameful path.

If he had chosen the former he could have seen any variation shown is due to statistical phenomena like regression to the mean.

I suppose it is the overblown image of self-importance that has led to the naming and shaming. First, Dr Snell and his SHA assume the QOF measures quality. But any straight-thinking GP can see it measures aptitude to data accumulation and has nothing to do with quality.

Then they introduce an arbitrary unscientific and unvalidated threshold retrospectively. It is perhaps telling Dr Snell did not stick around to work under this wonderful new quality framework, but chose to move to an ivory tower after inflicting a lifetime of drudgery on to GPs.

I suppose it goes to show why it is a bad idea to let data fetishists and computer nerds design values and benchmarks for services in the real world. As Albert Einstein said, not everything that can be measured has a value, and not everything that has a value can be measured.

Dr Hank Beerstecher

Sittingbourne, Kent

I am pleased to see Mr Squeers is not wasting his retirement from Dotheboys Hall, as he now appears to have taken up the directorship of teaching at Heart of Birmingham PCT (News, June 18).

It was also pleasing to see the BMA at long last standing up for the birthright of the profession to put our own interests before that of our patients.

Thank God and Queen Victoria that the trend towards senseless modernisation has finally ceased. I'm just off to beat my servant.

Dr Tim Heywood

Hagley, Stourbridge

West Midlands

Unbelievable! In your lead story (News, June 18) you document the understandable uproar concerning a PCT 'naming and shaming' underperforming GPs and then proceed to publish those figures.

How much did the PCT pay you to do their job for them?

GPs are hounded by institutions with their own agenda, such as the BMA/Government/GMC ­ now the magazines supposedly written for us start attacking us.

Dr Stephen Shepherd

Belper

Derbyshire

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