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Square root reform won't make QOF fair

I would like to reply to Dr Alan Keith's letter. I found Dr Adam Pringle's debate piece very reasonable.

GPs usually choose the area they work in knowing full well what the demographic is like. And there are QOF points for a number of illnesses but not all. Maybe Dr Keith has lots of refugees with no English too, and if so he will know they take at least as much time as patients with hypertension, yet receive no funding from the QOF. Similarly, students have higher rates of psychological illness and although depression is incentivised the indicators are not in my view appropriate. How are payments decided? It is all very arbitrary.

I would be happy to remove the QOF altogether rather than spend much of our time trying to gain financially by performing tick-box medicine that may or may not ultimately prove appropriate. If the incentives for, say, cholesterol control had been attached to HRT when it was all the rage, there might have been a lot more breast cancer as women were pressurised into taking it for the doctor's monetary gain.

From Dr Peter Wilson, Hounslow, London

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