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The three worst QOF indicators?

I strongly suspect, though haven’t fully tested it out, that an anagram of ‘Quality and Outcomes Framework’ would be, ‘Which f***wit thought this pile of crap up?’ The second word definitely works.

In our practice, as in yours, we’re trying to shoehorn shedloads of frenetic box-ticking activity into the last couple of months of the QOF year. Patients are being recalled, jabbed, measured, reviewed, interrogated and so on just so we can squeeze the last bits of QOF juice out of them. Were it not for the fact that I have a mortgage to pay, it would make me feel thoroughly sick.

The grim reality is that, with stiffer thresholds, tighter deadlines and a whole circus-tent full of new hoops to leap through, it’s only going to get worse. In an effort to distract myself from this awful prospect, I’ve been trying to work out which QOF activity is most pointless/soul destroying.  There are so many to choose from.

My top three are, in reverse order:

3. CKD6, the need to check CKD patients for ACR/PCR in the last 15 months. Christ, what a faff: bottle, form, label bottle, fill out form, explain to patient, and for what? Six points and urine stains on the reception desk.

2. DEP1, the need to case-find depression in those patients on the diabetic and CHD registers using two standard screening questions. I confess, I cheat. I don’t ask the questions but I tick the boxes anyway. Take me to the GMC, I don’t care. I don’t need to ask them. One third of attenders are known to be depressed, and that’s before they’ve seen me. Guess what, you’ve got diabetes and/or CHD too, feel like celebrating? Of course they’re depressed. I’m depressed. We’re all depressed.

1. COPD10, the need to check FEV1 in patients with COPD in the last 15 months. Has this ever led to a change in management that wasn’t going to happen anyway? No. It’s literally a complete waste of breath. The truth is, an FEV1 check involves a patient blowing in one end and money coming out of the other.

God, this is demeaning and demoralising. If I could be permitted one further swear, I genuinely wish that those behind this process would, once and for all, f**k QOF.

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