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Gaming? Talk up QOF's successes

I read with dismay the findings of the Centre for Health Economics study leading to accusations of gaming by GPs to achieve QOF payments (News, 7 June).

This is a stark example of how statistics can be twisted to prove anything. The study was Government funded and the report discussed the researchers' concerns that high-performing practices were artificially elevating prevalence figures and poor-performing practices were removing patients from registers to make targets easier to achieve.

To anybody who has worked on the QOF it is immediately clear that the best-performing practices will have systems in place to ensure that patients are correctly coded on to registers. These practices devote resources to updating registers and to maintain the hard work done in year one. It is no surprise that they identify more patients year on year through such proactive work. Conversely, struggling practices will have less complete registers.

They may lack the systems to keep their registers up to date and maintain the hard work put in during the first year of QOF, when registers were given a high priority. Similarly, exception coding should clearly go up year on year as practices become familiar with coding of exceptions and develop more systematic recalls.

In previous years many patients suitable for exception coding were simply not coded as practices did not have systems in place to identify them.In addition to Read coding activity, GPs are now recording reasons not to treat, whereas this was done far less systematically prior to the QOF.

Within the NHS, primary care is one aspect that works extraordinarily well and is admired by health planners across the globe. If the Government spent as much energy highlighting the fabulous achievements of the QOF as they do desperately trying to find scraps of data with which to undermine GPs, then the public's belief in the NHS would have continued to be an important vote winner.

From Dr Martin Bethell, south London

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