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Study puts a spin on QOF gaming

The report from the Centre for Health Economics (News, 7 June) on disease prevalence was a sophisticated mathematical analysis of the QOF data in Scotland only for the first two years of the new contract.

It did not look at the actual behaviour and motivations of practices.Its first conclusion, which you did not report, is that 12.5% of work toward QOF targets is unrewarded because of the system of setting upper thresholds. This is by far the most significant factor.

The report frequently uses the word 'gaming' but this is certainly not synonymous with fraud. It simply refers to actions taken by a practice to maximise QOF income. For instance, a practice that is coping well with QOF may decide to use PRIMIS CHART software to make sure that all coding is correct. If this was not done by practices coping less well with QOF, it would be interpreted as gaming.

Similarly, it is not surprising that practices struggling to reach an upper threshold should use more exception reporting than those above it who have no incentive to exception-report. No effort was made in the study to separate the different reasons for exception reporting (for example, informed dissent or new patient).

Although this analysis shows some interesting patterns, it is unfortunate the results tend to be spun in a negative way to suggest fraud. Seeing unsupported accusations in an otherwise thorough work is disappointing.

From Dr Gavin Jamie, Swindon, Wiltshire

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