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Letter of the week: QOF consultation misses the bigger picture

I have to express my dissatisfaction with the lack of clarity about consultation on potential new QOF indicators.

We do not have a real opportunity to influence or comment on potential QOF indicators at all.

I was hoping to have the opportunity to request paediatric and obstetric or gynaecological indicators, as many of us do an enormous amount of important work in this area.

Furthermore, I wanted to comment on the way in which the indicators are developing and detracting from good, thorough clinical care, becoming a tick-box exercise with no real value whatsoever and reducing the time for patients.

But NICE's pro forma allows for very specific input only, which is not acceptable under the guise of a consultation.

The bigger picture is once again being missed here: that the increasing tick-box nature of care is damaging rather than enhancing patient care.

For example, my depression assessments are incredibly long and thorough, and I cover every aspect of the patient's care and needs, often accommodating for secondary care failings with no recognition of this input.

I perform a thorough assessment of mood and function and do not like to repeat the PHQ tick-box style questioning – as it detracts from the time and personalisation of the assessment.

Yet a perfunctory assessment and ‘ticking the boxes' by another doctor will achieve full points.

The QOF is not addressing key quality issues with patient care, and is unnecessarily time-consuming and onerous without measurable quality improvements.

What is more outrageous is that there are no paediatric, gynaecological or obstetric indicators, despite these being key areas highlighted for focusing on by public health.

Surely the children of today are the potential diabetics and COPD patients of the next decades, and so we should be actively intervening – yet QOF, being politically driven, focuses on meaningless short-term goals pursued at the expense of real investment in long-term health improvements.

The question you should be asking is: ‘What indicators do we as healthcare providers, with responsibility for our patients' welfare, feel should be employed?'

Your supposed consultation is no consultation at all and needs to be opened up and challenged urgently.

From Dr Ismat Nasiruddin, Balham, south London, open letter to NICE

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