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Let the QOF do the navigating while you enjoy the journey

Like satellite navigation systems, QOF prompts can be infuriating – but surely GPs should welcome a system that does the donkey work, freeing them up to do more interesting things, says Dr Jessica Harris

Like satellite navigation systems, QOF prompts can be infuriating – but surely GPs should welcome a system that does the donkey work, freeing them up to do more interesting things, says Dr Jessica Harris

I was driving down a quiet country lane, lost in thought, when my sat nav barked out a sudden warning. I cursed it. And that's when it struck me – it's just like the QOF.

But before I get onto that, I have a confession to make – I'm a GP QOF assessor. In fact, this insight came to me while on my way to a QOF visit. I've been broadly positive about the QOF since it began, and still am. On my visits I've met with various attitudes to it, usually strongly felt, often pretty damning. I'm writing this piece to see if I can persuade some of you to see it from my point of view.

So back to sat navs and the QOF – what's the connection? Both are complex mechanisms designed to assimilate and manipulate large amounts of data. Messages are triggered that prompt us to take certain actions to achieve particular goals. Both offer guidance rather than orders. You can ignore them either purposefully or by oversight without causing meltdown – they will recalibrate if necessary. Neither is essential to the task in hand. We could use our brains to do the job instead.

Complex world

So why bother with such systems? We live in an increasingly complex world. Some

of the groundwork for the decisions we make can be reduced to a set of complex calculations. Computers are better at these than we are. They leave our brains freer to assess the answers the computer throws

up – judging whether we agree with the advice, taking into account the things we know a computer is insensitive to. This is the subtle stuff that human brains excel at. So we're not moving into a freaky 2001 Hal existence where we are ruled by computers. We are still in control, just taking advantage of the digital age.

What the QOF does, like a sat nav, is free us from the cascade of data-handling and decision-making, creating welcome space in our cluttered brains. Our brains, freed up, switch to more interesting things. But here lies the paradox. When a prompt appears, the natural reaction is to be annoyed at the interruption, not grateful to the gizmo for doing the donkey work.

I was attracted to medicine, to general practice in particular, because it is a blend of art and science. The depth and complexity of human characters and relationships combined with the inherent satisfaction of pure logical thought. As

time goes by, perhaps as my understanding of human nature deepens, I find the qualitative aspects of the job increasingly rewarding. But from a quantitative point of view, I'm close to drowning in a tsunami of information. I can no longer even aspire to keep on top of all of the studies, guidelines and edicts. One reaction would be to retreat into the comfort of what I think I do well, and wall myself off from all the other mass of information. I could pick holes in papers and guidelines along with the best of them, to justify this stance. But would this be fair to my patients?

As GPs we have to do both the qualitative and quantitative aspects of medicine, or we're no better than quacks. And if the QOF helps us then we should welcome it with open arms, irritating though it may be at times. I disagree with some of the details,

as I'm sure most GPs do, but that's not to reject the whole concept. The software is pretty clever if it can remember all those endless evidence-based guidelines, and all the revisions to them, and to point us towards putting evidence into practice for this patient, and the next, and the next… not just when we have the time or the inclination.

Independent thinkers

The analogy with sat navs is not perfect, of course. The fundamental difference is that we choose to buy sat navs, whereas now the QOF is here we have little choice but to follow it, or else we lose money. GPs are,

by their nature, intelligent, independent thinkers. We have been encouraged to think like this us throughout our training, and by our self-employed status. It's natural for us to baulk at having such an elaborate scheme thrust upon us, even if there is good in it. On top of this the financial incentive is far from subtle demeaning to our professionalism and distorts the relationship with our patients. I wonder if there is a better way.

In behavioural economics there is a concept called ‘nudging'. It means taking human nature into account when designing systems, and incorporating ideas that steer people towards actions that they would probably want to take if they stopped and thought about it, but often don't.

A good example is in Schiphol airport, Amsterdam, where a designer decided to etch drawings of flies onto the porcelain near the drains in the men's urinals.

As a result men took better aim and spillage onto the floor fell by 80%. An inventive way to improve actions without coercion and give people something to smile about at the same time. I wonder what that designer would come up with if let loose on the QOF?

I do understand the negativity about the QOF. Both because of the way it was introduced and the irritation of interrupted consultations. But the fundamental idea of getting computers to do the donkey work, so that we can do more skilful and interesting things, has to be good. For us, and for our patients.

Dr Jessica Harris is a GP in Eynsham, Oxfordshire, and a QOF assessor for Oxfordshire PCTs

Let the QOF do the navigating

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