Since QOF was introduced in 2004, general practice has adapted to the new challenges given by the government but we haven’t always felt they were to improve patient care or reduce variations between quality of care in different areas. Some of the parameters have been questioned, but understanding that one of GPs’ main incomes was coming from the QOF meant that most doctors achieved more than expected.
Every year clinical domains have been changed, sometimes giving the required Read codes to score late in the year, or even changing the accepted code. For example, this current flu season the Read code accepted was suddenly changed from ‘influenza vaccination’ to ‘seasonal influenza vaccination’. Earlier in the year the asthma codes for the 3RCP questionnaire were not clear until well past September, some five months after coding asthma reviews.
But somehow we keep achieving the new and old targets, and it seems it is not enough to raise them, but now when secondary care is shrinking and practices are taking already on extra work, we are facing a new more problematic situation.
The battle for prevalence
The QOF proposed for 2013/4 year does not present any new parameters, if anything there are less, and there is less money available on them.
You need to improve, if possible, on your QOF scoring, and try to maximise your income although probably it is going to mean we are fighting each other in a battle of prevalence.
This is what is meant by ‘battle of prevalence’: most QOF points are not paid at standard value, but there is a conversion rate based on the prevalence of the disease at practice level, compared to national level.
So, for example, if you think about palliative care (a simple one), you only need to have one patient in the register to qualify for three QOF points.
But even though the national prevalence is only 0.2%, one single patient could imply your prevalence is perhaps 50% of the national, and your three points will dilute to half their standard value.
What then about your prevalence of diabetes, asthma and the others? Maximising the prevalence will improve you income, but then you are fighting against the other practices for this elusive ultimate price of ‘best prevalence’. But if you decline to chase QOF points, you will need to undertake more work for the same funding, for instance by agreeing to more DESs than previous years.
At the end of the day we are going to be working harder, and the quality of our care not necessarily is going to improve. Now starts a fight for survival.
Dr Pablo Millares-Martin is a GP in Leeds.