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F*** QOF



F**k QOF. But no matter how often I say it – and I do, repeatedly, and I suggest you do, too – it won’t. Tragically, rumours of its imminent demise have been greatly exaggerated.

So, despite the BMA’s urgent prescription for general practice demanding, all of ten months ago, an urgent prescription of intravenous potassium, QOF staggers on to box-tick another day, or, rather, for another year.

True, it’s not being augmented or tweaked, which is a small mercy. But it’s noteworthy that NICE advisers apparently still can’t stop themselves from churning out new sets of indicators – such as those built around the latest de rigeur default hospital diagnosis aka thing we GPs need more education in/awareness of/bollocking over, which is, of course, AKI – even though these will be indicators all dressed up but with no place to go.

But maybe this does, at least give us a glimpse of the future. Because I reckon that existing Big QOF will be replaced, next year, by a Little QOF, not unlike this latest set of indicators which is currently wandering around all lost and homeless. But when I say replaced, I actually mean Big QOF will get swallowed up as a contractual requirement with ‘routine data collection’ via CQRS, which we shall choose to call ‘covert performance management’, because that’s what it is. But we’ll be too distracted in trying to tame the new Little QOF to notice.

Repeat annually thereafter, with the previous year’s mini-QOF becoming contractual and monitored, and new indicators being introduced with a financial carrot which becomes the following year’s thumbscrews.

End result: an annual ratchetting up of expectation and scrutiny until our eyeballs bleed. And it’s about that point that we’ll think the unthinkable and also recall an undeniable contractual truth. Specifically, that you miss old QOF, and that whatever replaces what you always thought was as bad as it could get is always far, far worse.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield