By Christian Duffin
RCGP chair Dr Clare Gerada has hit out at the measurement culture in general practice, which she says has ‘distracted’ GPs and forced them to focus on hitting targets rather than using their clinical judgement.
Speaking during a panel debate at the NICE annual conference in Birmingham this week, Dr Gerada said the strict requirements in both NICE guidelines and the QOF have led GPs to concentrate on ‘measuring things’ rather than excercise their clinical judgement.
Dr Gerada criticised some of the principles behind the QOF, and also launched an attack on NICE for producing guidelines that she claimed ‘don’t work’.
She cited the measurement of HbA1c values in diabetes control as an area where there was an over-emphasis on measurement, and said that sometimes GPs were ‘managing patients to within an inch of their lives’.
Dr Gerada added: ‘Over the last ten years we’ve been distracted by measuring things. Our QOF is not about making clinical judgements. We have gone so far down that line that clinical judgement plays only a part in it.’
On NICE guidelines, she said: ‘The problem with NICE is that it delivers disease specific guidelines – but we don’t have disease specific patients. Sometimes we have four or five different guidelines for one patient – and some of these guidelines are mutually exclusive. I do value NICE guidelines. But for treating patients they just don’t work.’
Dr Gerada said that the multiple guidelines represented a ‘forest of activity’ for GPs to contend with. But NICE chair Sir Michael Rawlins defended the guideline documents, and stressed that NICE guidance was intended to help GPs, and not to force them into decision-making against their clinical judgement.
Dr Clare Gerada: NICE and QOF force GPs to place too much emphasis on measurements