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At the heart of general practice since 1960

Where’s focus on patient care?

Cast your mind back to 2003 and the debate over the merits of the QOF – which, in the days before extended hours, was then the Government’s pet health policy.

Cast your mind back to 2003 and the debate over the merits of the QOF – which, in the days before extended hours, was then the Government's pet health policy.

Some saw the QOF as a bold and ambitious attempt to drive up GP performance, others a depressingly reductive exercise in ticking boxes.

But even the harshest critics had to admit one thing: ministers were at least making a genuine attempt to improve the standards of patient care.

But something, somewhere has gone awry. As GPs cast their eyes over the current, battered landscape of general practice, and the car wreck that is the contract negotiations, it is increasingly hard to see where patient care fits in.

We already knew the Department of Health had turned down the opportunity to buy 38.5 clinical points on osteoporosis, peripheral arterial disease, heart failure and chronic kidney disease, preferring to splash the cash on longer hours.

Loss of focus

Now we learn that private companies are being allowed to win APMS contracts by undercutting on cost by as much as 20%, even as they fall short under official evaluation on the range and quality of the services they will provide.

On prescribing incentives schemes, too, patient care seems to be taking a back seat, with 15% of trusts paying inducements to GPs to ignore QOF targets in favour of cash savings.

The NHS of 2008 has become a highly efficient cost-cutting machine, slashing its way from deficit to surplus in the space of two years.

It has become finely tuned to the needs of marginal constituencies, with a focus on GP access that is all-consuming to the point of weirdness.

But as the health service gains in budget surplus savings and electoral brownie points, it is in danger of losing its focus on the clinical care of patients.

And if it does that, it could lose GPs too – metaphorically, and perhaps even literally.

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