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At the heart of general practice since 1960

F*** QOF

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F**k QOF. But no matter how often I say it – and I do, repeatedly, and I suggest you do, too – it won’t. Tragically, rumours of its imminent demise have been greatly exaggerated.

So, despite the BMA’s urgent prescription for general practice demanding, all of ten months ago, an urgent prescription of intravenous potassium, QOF staggers on to box-tick another day, or, rather, for another year.

True, it’s not being augmented or tweaked, which is a small mercy. But it’s noteworthy that NICE advisers apparently still can’t stop themselves from churning out new sets of indicators – such as those built around the latest de rigeur default hospital diagnosis aka thing we GPs need more education in/awareness of/bollocking over, which is, of course, AKI - even though these will be indicators all dressed up but with no place to go.

But maybe this does, at least give us a glimpse of the future. Because I reckon that existing Big QOF will be replaced, next year, by a Little QOF, not unlike this latest set of indicators which is currently wandering around all lost and homeless. But when I say replaced, I actually mean Big QOF will get swallowed up as a contractual requirement with ‘routine data collection’ via CQRS, which we shall choose to call ‘covert performance management’, because that’s what it is. But we’ll be too distracted in trying to tame the new Little QOF to notice.

Repeat annually thereafter, with the previous year’s mini-QOF becoming contractual and monitored, and new indicators being introduced with a financial carrot which becomes the following year’s thumbscrews.

End result: an annual ratchetting up of expectation and scrutiny until our eyeballs bleed. And it’s about that point that we’ll think the unthinkable and also recall an undeniable contractual truth. Specifically, that you miss old QOF, and that whatever replaces what you always thought was as bad as it could get is always far, far worse.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (7)

  • I love QOF, it is achivable without it the basics would not be achived.

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  • Absolutely agree.

    I can't believe GPC cannot see this. I suspect (and I'm not a conspiracy theorist) they do know the intentions but they are either hopelessly incapable of addressing it or they are choosing to service their own personal agenda and selling the profession down the river.

    You'd know latter is the case if the GPC chair gets a gong. Oops, hasn't this happened already?

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  • BMA, more commissars shooting the front line troops in the back,while the troops fight the overwhelming assault from the front.

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  • Oh I don't know. I spent about 3 hours this afternoon correcting and recoding some notes. I recon that's another £10,000 for the practice. If that's not NHS money well spent I don't know what is. I'd would have done more but had to see some patients. They just seem to get the way of the real purpose of the NHS. Box ticking.

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  • Siraj Shah

    A high QOF score does not necessarily indicate high quality care, any quality indicator that is financially driven and data open to manipulation is unreliable. In my opinion financial incentives to improve population outcomes do not work, despite spending 5.86 billion on QOF incentives it has led to no significant improvement in mortality rates (Lancet).

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  • Like any other tick box initiative QOF is entirely manageable if you attack it correctly (we score 100% again this year). Requires planning- especially about the minimisation of clinician input but still getting boxes ticked- doesn't actually improve patient care but there again QOF was never going to do that was it?

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  • Surgeons were once asked if they would like strict lists of checks to be undertaken prior to surgery in the same manner that happens prior to flights. Most were vehemently against them.
    The surgeons were then asked if they would like others to have to do this prior to surgery that they were receiving. The majority would.
    The intent of QOF is that it ensures a basic standard of care to all patients. The reality is that it is often viewed as a way of generating income and that as long as the boxes are ticked, that is all that matters - calling up patients to ask regarding smoking and the single letter to asthma patients for a review I doubt was the intent.
    But this is not a failing of the system, but those who are intentionally misusing it.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder