QOF is leaving GPs little room to focus on patient-centred care and is turning patients into ‘passive subjects of surveillance’, concludes a new qualitative study.
The UK researchers audio-recorded GP and nurse practitioner consultations with 34 patients with long-term conditions (LTCs) at six practices in one PCT in north-west England. They then interviewed both the patients and practitioners using the taped recordings to assist recall. Patients were also asked to complete weekly logs about their health service use, and interviewed a second time after three months of follow-up.
The researchers identified ‘divergence’ between the patient’s presentation and the GP’s or nurse’s response in 27 cases, whereby patients’ informational, emotional or biomedical needs were not met. For example, in one case a GP failed to address a patient’s presentation of possible memory problems, bypassing this to focus on the QOF template of blood and urine tests. However, the team highlighted two cases in which GPs gave the patient’s needs priority over the QOF requirements, in one case to deal with a patient’s concerns about her cancer-related issues and in another to explore the effects of a patient’s recent bereavement.
What this means for GPs
The authors said that QOF was making patients take the role of ‘passive subjects of surveillance’. They added that QOF needs to evolve to accommodate the challenges posed by multimorbidity and that there need to be ways ‘of bringing the psycho-social domain and a patient-centred approach into consultations alongside, or as part of, QOF in ways that do not reduce patient-centred care to “tick-boxes”. They concluded: ‘Addressing the tensions between the patient-centred care, responding to patient priorities versus delivering evidence-based care constrained and dictated by QOF might be achieved by longer consultation times, the use of innovative tools, and greater continuity of care.’