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Plans to use the QOF to tell GPs what not to prescribe lead Copperfield to wonder if his clinical judgment counts for anything any more

Plans to use the QOF to tell GPs what not to prescribe lead Copperfield to wonder if his clinical judgment counts for anything any more

I let rip a bloodcurdling howl the other day. It was provoked by a sneak preview of some proposed new QOF-tastic targets. It seems someone has had the novel idea of rewarding us for not prescribing something - specifically, antipsychotics to patients with dementia, in case of cerebrovascular 'accident'. Which means we're going to have trouble with the Neurofibrillarily Tangled at the local nursing home. The patients will be a nuisance, too.

I can't wait for the annual QOF visit. 'So, Dr Copperfield, can you tell me exactly how often you didn't prescribe these drugs?' 'Sure, I didn't prescribe them every day.' 'With what instructions?' 'One, not to be taken daily, on an "as unnecessary" basis.'

There's an amusing get-out clause, too, whereby we're permitted to neurolepticate to the ker-ching of QOF points - provided we have the demented's informed consent. No problem: 'Can I just confirm you realise I'm not the Prime Minister and that seven from nine is two? Excellent, sign here and open wide.'

But the comic relief doesn't compensate for the fact that these QOF tweaks drive us mental. And they're further evidence - like we needed any - that the hoop-and-hurdle setters are living on another planet. Presumably, one where the oxygen has been replaced by nitrous oxide.

Yes, I realise that antipsychotics are best avoided in patients with dementia - but there comes a time when I will resort to the FP10. Such as when the nursing home manager is on the phone begging me to do something about a patient who's setting fire to other inmates and impaling extinguisher-wielding staff with his Zimmer frame.

The worthies suggest alternative approaches to these behavioural problems. When pushed, they'll mumble vaguely about, say, the calming effect of music. Great. 'Doctor, we've tried the Vivaldi like you said, but he's still gnawing our ankles. Should we crank up the volume, or it is time for Mahler?'

Besides, if all other avenues really have been explored, why is the risk of a stroke - given the circumstances - such a big deal? If the alternative is to be sectioned off to a psychiatric ward where they'd prescribe the same drugs anyway, if it were me, I'd pop the pills - particularly as the only disadvantage is that I'd continue to drool vacantly in front of Jeremy Kyle, but possibly with a more lopsided mouth.

There's more to my anguish, though. There's also the fact that this is yet another example of us GPs being micromanaged and nanoscrutinised. I'm a generalist. The deal is, I do 90% of everything to a 90% level of competency. It's a brilliant and cost-effective system. Trying to squeeze that last 10% from us requires enormous pressure and resources, and gives only a tiny return, while pissing us off in the process.

Sooner or later, someone will realise how misguided it is to continue dismantling general practice to its constituent parts in an attempt to carrot-and-stick us into compliance. Trouble is, when we come to put our deconstructed role back together again, it won't work, because there will be bits missing. GPs, probably.

And that really will be something to howl about.

Copperfield

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