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Our new blogger is frustrated by the tickboxing and wonders what it actually achieves

Our new blogger is frustrated by the tickboxing and wonders what it actually achieves

I'm stewing about the QOF, in particular the farce of diabetes targets ( HbA1c ) that perversely encourages us to overtreat the frail elderly with unrealitic and potentially dangerous polypharmacy. Soon we may not even be allowed to exception report to prevent GPs ‘gaming'. Why do we collect urine for microalbuminuria every year in case proven microalbuminuric diabetics ? Why do we have to do obligatory reversiblity testing in COPD when our local specialist says its usually a waste of time? And PHQ9s, don't me started .

The misconception is that such preventive medicine always saves money.

It may well create a healthier population for longer but the expediture is simply deferred. It is incurred in the last six months of life , whenever that may be. We live longer yes, utilising services along the way, good, but it costs.

It also costs to chase every blood test and follow up every minor irregularity, engendering patient concern along the way. Whilst GPs are busy advising 85 year olds about their low fat diets they have less time to care for the ill. So we admit or refer. This makes QOF a commissioning issue.

So does NICE guidance. We are currently struggling to utilise the services of an indepenedent dermatologist in skin cancer care because NICE uses the term ‘hospital' consultant.

The folks who write these things now need to consider the knock on effects and the global healthcare economy. Perhaps it could be run by a commisioner forum - The Forum of Fiscal Frameworks, F-OFF.

Dr Clive Henderson is chair of Goole, Howden and West Wolds locality commissioning group

Dr Clive Henderson

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