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At the heart of general practice since 1960

GPs cannot cure all society's ills

Driving blindfolded without access to the gears or the brake would be sheer lunacy. But that is what GP practices are, in effect, being asked to do under the latest QP indicators introduced into the QOF in a bid to reduce A&E attendances

Driving while using a mobile phone is illegal. Driving blindfolded without access to the gears or the brake would be sheer lunacy.

But that is what GP practices are, in effect, being asked to do under the latest quality and productivity (QP) indicators introduced into the QOF in a bid to reduce A&E attendances.

As we reveal this week, nearly a third of practices have fallen at the first hurdle – either requesting an extension or completely missing the deadline to hold a practice meeting to review the reasons for A&E attendances by their patients.

GP leaders in some areas are blaming PCTs' failure to provide the A&E attendance data that would underpin practices' review meetings – though they also acknowledge some apathy among GPs about the thankless task they have been given.

If all of this sounds familiar, that's because exactly the same issues bedevilled the QP indicators on referrals, prescribing and emergency admissions last year, with PCTs failing to provide key data and, as a result, practices struggling to maintain their QOF income.

From the start, the rationale for these indicators was flawed. The academic literature on ever-increasing A&E attendance rates is scant, but what there is indicates that to make a real difference deep-seated socioeconomic problems, transportation issues, GP out-of-hours provision and the location of NHS services would all have to be addressed.

GP practices can tinker round the edges of this huge problem, but how can it be fair to expect them to effect real change when they do not have access to the multifaceted levers that could make a difference?

The emerging evidence of problems with this year's A&E indicators follows on from statistics showing only 72% of practices achieved maximum income for the QP prescribing indicators last year. This raises uncomfortable questions for GPC negotiators who have agreed to targets that sit poorly with the raison d'être of the QOF.

The QOF was meant to be a strictly evidence-based mechanism to incentivise good practice in the care of patients – yet it's increasingly being used to tie GPs' income to the hopeless task of attempting to change patients' wayward behaviour.

Further evidence for this disturbing trend comes from the news that the Government is planning to ring-fence 15% of QOF points for public health indicators – so GPs can look forward to seeing more of their earnings tied to a responsibility to cure society of ills ranging from obesity to excessive drinking.

Holding GPs accountable for things they have little means of controlling will only alienate and further demotivate the profession.

The reach of primary care is broad, but not ubiquitous. GPs are not gods, and they cannot cure all ills with a wave of their magic stethoscope. The sooner ministers realise this, the better.

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