With respect to the quality and productivity indicators in the current QOF, are we once again performing tick-box exercises that will keep somebody in post to analyse returns and produce reports and guidelines?
Or does anyone believe anything will change?
Surely the biggest elephant in the room is demand management – especially as it should be ‘expectation' management.
The problem with our no-win-no-fee, 24-hour, home-shopping society is that expectations are increasing and directly driving demand.
As practitioners who have worked hard to build our careers, is it not reasonable for us to err on the side of caution (defensive medicine, to stave off offensive patients)?
It's all very well pressurising primary care to control A&E and out-of-hours attendances, but what is the solution? That we open 24 hours a day?
What kind of ‘quality' would that deliver, besides a conveyor belt of minor issues?
Surely, the approach which is required is a unified, coherent message to the public to self-manage more, to realise the health service has boundaries and – if needs be – to reset the limits of what is and what isn't ‘medical'.
To take this further, perhaps PCTs should publish a cut-out-and-keep supplement in their local newspapers of conditions which are not funded to stem referrals at source?
From Dr Hrishikesh Pathak
Stoke-on-Trent
