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Dinah's week is marred by bad press on GPs and nerves over the practice QOF check


Journey to work soured by anti-GP sentiment on the radio. What has everyone got against GPs at the moment?

Or rather, against GPs earning a decent income? Newspaper references to greedily defrauding the NHS, GMS pay deal talks collapsing, PCTs trying to claw back QOF payments. It's infuriating – we had a deal, we delivered and what do we get? Accused of cheating.

Meeting with community nursing managers: a new district nursing sister is attached to the practice – hooray!

Fell out with the old one last year. I only asked her to check a patient's smoking status – she was visiting anyway, to check his BP.

She said it was a waste of her time. Several complaint letters to PCT later, dictaphone still fuming, I suspended all further PHCT meetings.

Meeting dominated by big rows about district nurses not doing QOF work because they don't get paid for it.

Surely it's everyone's job to check smoking status and encourage cessation?

I've been sending the practice nurse into people's homes for several months to do COPD and diabetes checks that community teams can't or won't do – so I'm paying her to do work that some DN teams deliver. What's fair? Patients need the care.


PBC meeting. Going through shortlisted local development plan proposals; practices worrying about starting the year in deficit so reluctant to invest any growth funds at this stage.

Went for direct access echos and MRI – but threw out community phlebotomy. Still, we can't make any firm decisions without budgets; must keep pressing for more financial info especially all PCT funds mapped down to practice level.

Surgery. Frantically reviewing QOF achievement – PCT coming for annual check this week. Dementia register looks a bit low – had better double check before 14 February (National Prevalence Day).

Running late – spent too long trying to do mini mental test scores from Alzheimer's website on everyone. Also embarrassed myself as unable to do serial 7s, must look into Aricept.

Hope our QOF check goes okay – new computer seems good but some data has come over from old system incorrectly. Run out of time to check as late to pick up kids at station.


New DN wants to do Gold Standard Framework for palliative care – very welcome, but one big problem: unfortunately palliative care register currently has zero patients.

Started year well with three; I suppose some turnover must be expected, but it doesn't matter how well we looked after them, once they've gone to a better place the register reverts to 'nul points'.

No credit, no QOF points, no prizes! We found one patient who could qualify now; I only hope they last till April...

Didn't need to worry about QOF visit after all – apparently we are 'light touch' and keep exceptions to a minimum.

Luckily clinical assessor knew the computer system better than I do – picked up loads of tips! Sighs of relief all round.

Dinah Roy is a GP in Spennymoor, County Durham. She is also chair of Sedgefield PBC group and a member of the joint PEC of County Durham and Darlington PCTs

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