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The new QOF on diabetes is neat – and very, very nasty

OED definition of the verb, ‘to QOF’: 

1. To ensure patients receive high quality, evidence-based care.

2. To turn the patient upside down and shake them until no more money falls out of their pockets.

Which definition you use depends on your steel to fluff ratio, I guess. And, although in my case, that’s 99.99 to 0.01, I have to admit that, when QOF was first invented – with all its attached promises of being evidence based and rewarding new work etc – I was pretty impressed.

Over the years, though, the suits – gobsmacked at how easily we hit targets, which is another way of saying they had no idea how superb primary care already was – have repeatedly cocked it about, turning it from a justified carrot for quality care into a cattle prod for refusing to jump through increasingly stupid hoops. So we’ve had points deviously redistributed, bonkers new areas, evidence-free zones, a draconian ramping up of targets, and so on.  

The thumbscrews have been progressively tightened, in other words. And with their latest wheeze, they’re really going to hurt. Because the Big New Idea is to bundle up the existing indicators for diabetes into one big tick box the size of a house: miss one, you miss the lot. Neat, and very, very nasty – and no reason why they should stop with diabetes, either.

All I can say to that is this: you bastards. Oh, and to offer you another definition. ‘Qoffin: the wooden box all this punitive box ticking is driving us into’.

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