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QOF architect downplays workload impact of new depression indicator

The additional psychosocial checks in patients with depression proposed for next year's QOF will not substantially increase GPs' workload, according to the GP at the heart of developing new clinical indicators.

In an exclusive interview with Pulse, Professor Helen Lester, clinical QOF indicator development lead, defended the proposal to introduce a new extended biopsychosocial assessment tool for depression into the QOF from 2013/14, subject to GPC and NHS Employers approval.

Some GPs had raised fears that the extensive questioning model would introduce too much box-ticking to the doctor-patient relationship, increase workload and unfairly task GPs with solving wider social problems.

But Professor Lester, professor of primary care at the University of Birmingham and a GP in the city, told Pulse that GPs would not have to complete the full model to fulfil the QOF point requirements or ask the questions exactly as they are set out in the assessment.

The assessment is divided into 16 ‘themes', including a patient's symptoms, any alcohol and substance use, suicidal ideation and any family history of mental illness. The assessment tool also investigates the quality of interpersonal relationships, social support, living conditions, any employment or financial worries and includes a discussion about treatment options.

Professor Lester said: ‘Ask the key questions – talk about family history, personal circumstances and make sure to ask about alcohol use. This is what every good GP does anyway. The QOF is just supposed to be a reminder of what is good clinical practice.

‘How you carry out the assessment is down to your personal style. Nobody is saying you have to ask all the questions in a certain order.'

Professor Lester also discussed QOF indicator development, funding and why certain ailments are not suitable to be part of the QOF.

She said it was her view that QOF should represent a smaller share of the overall funding to practices than its current 20% level: ‘In other countries that use paper performance, the proportion of overall funding is closer to 7%. That means we assign three times as much as many others think should be put down to paper performance. My personal view is that 20% is probably a bit too much.

‘But, interestingly, when we put that question to our pilot practices they tend to think it is about right.'

Click here to watch the full Pulse video interview with Helen Lester

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