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NICE guidance costs more than it saves

Well said, Dr Clare Gerada. It's nice to have like-minded individuals in charge.

I'm stewing about the QOF, in particular the farce of diabetes targets that perversely encourage us to over-treat the frail elderly with unrealistic and potentially dangerous polypharmacy. Soon we may not even be allowed to exception report to prevent GPs ‘gaming'. Why do we collect urine for microalbuminuria every year? Why do we have to do obligatory reversibility testing in COPD when our local specialist says it's usually a waste of time? And PHQ9s – don't get me started.

The misconception is that such preventive medicine always saves money. It may well create a healthier population for longer, but the expenditure is simply deferred. It is incurred in the last six months of life, whenever that may be. We live longer, yes, utilising services along the way, good – but it costs.

It also costs to chase every blood test and follow up every minor irregularity, engendering patient concern along the way. While GPs are busy advising the elderly on their low-fat diets, we have less time to care for the ill. So we admit or refer. This makes the QOF a commissioning issue.

So does NICE guidance. We are currently struggling to use the services of an independent dermatologist in skin cancer care because NICE uses the term ‘hospital consultant'. The folks who write these things now need to consider the knock-on effects and the global healthcare economy. Perhaps it could be run by a commisioner forum – The Forum of Fiscal Frameworks, F-OFF.

From Dr Clive Henderson, York, Chair of Goole, Howden and West Wolds locality commissioning group, via