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I need something strong for this niggly QOF

I am aware, of course, of the current burning issue in general practice: If supplying NHS staff incurs VAT, but supplying NHS services doesn’t, what about supplying NHS staff who supply NHS services? Of all those fascinating VAT questions, this is right up there. 

But I want to talk about the QOF. Which isn’t that much of a subject swerve, given that its latest version is part of the new primary care network vision which, in turn, is responsible for our current obsession with all things VATable. Besides, if you check the brand new QOF ‘quality improvement’ section in the contract guidance, you’ll see the deadline for starting QOF version 2019 is precisely now.

You haven’t checked it, though, have you? Because there’s only so much guidance you can take, and when it’s a read-off between VAT and QOF there can only be one winner.

So I’ve digested it on your behalf, despite the fact that the blurb explaining the QOF quality improvement section runs to a dyspeptic 20 pages, or approximately 10,000 words. I have mentioned this before, but I will keep doing so, using up to 10,000 words if necessary, until we all realise just how hideous this latest QOF iteration is.

You will need to review how many patients you might be killing or maiming with NSAIDs

For the ‘prescribing safety’ section – and you have to appreciate that I’m paraphrasing an audit-junkie’s wet dream – you will need to review how many patients you might be killing or maiming with NSAIDs, lithium and valproate. Then you need to identify ‘quality improvement activities’ and ‘set improvement goals’. Then you have to devise and implement your plan. Then you have to re-audit to demonstrate what you have achieved. Then you have to compile a written report. And somewhere along the line you have to convene two peer-review PCN meetings to discuss it all.

Okay so far? Good. Because then you have to repeat all the above for end-of-life care. 

It’s surely no coincidence that the QOFficials chose therapeutics and palliative care to launch this 74-point monster: jumping through these hoops would make any rational being beg for a prescription for something to end it all. And to stop us recycling this year’s quality improvement labours, next time there will be two brand new topics to torment us.

So there we have it. On the one hand, as self-employed, respected professionals, we are being QOF nanomanaged ad absurdum. And on the other, as self-employed, respected professionals, we are being forced via the PCN project into macromanaging local health systems.

Somewhere between this nano and macro lies general practice. Remember that? Suddenly, fights with patients over antibiotics seem irresistibly attractive. Maybe that was the plan all along: give us so much other crap to do that we realise the day job wasn’t so bad after all, prompting a new and honest slogan for potential recruits: ‘General practice: a bit less shit than you thought.’

Genius, really, now I think of it. Those negotiators probably deserve a pay rise, though I’m obviously hazy on the VAT implications.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield


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