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You must be demented to put ethics above QOF payments



Being Chief Petty QOFficer, it falls to me to work out why our just-released QOF payment is, as usual, a bit below par. So I drill down into the data and, when I emerge, some hours later, it’s with the news that we have failed to mine one particularly rich seam. Our dementia prevalence is way off the national average, and some back-of-the-envelope number crunching shows that this alone has cost us a few thousand.

We know why. When those seek-and-destroy dementia DESs sprang up a few years back, we nobly resisted the get-rich-quick temptation in favour of a high minded notion that dementia screening has no validity.

Well, bugger that. As I now sit with my colleagues in the QOF debrief, all ethics have been ritually defenestrated. Number one on the agenda is, ‘Find more dements’. And number two is, ‘Then find some more’.

 We are looking for ideas, and there are plenty forthcoming. So. We could check every memory clinic referral against coded diagnoses to spot net-slippers. We could trawl all our residential homes on the basis that you don’t have to be demented to reside there, but it helps. We could ensure all repeats for anti-dementia drugs match with a dementia diagnosis, ditto for elderly on quetiapine, risperidone, lorazepam or any other psycho-lytic. We could search ‘memory problems’ in every patient’s journal narrative and code them as ‘dementia’ (subtext ‘possible’). We could make ‘Are you demented?’ our supplementary Friends and Family Question. We could get every patient to fill in a GPCOG as they sit in the waiting room. We could repeatedly ask, on the tannoy, ‘Do you know who, where and when you are?’ We could opportunistically stop and collect confused, wandering elderly people as we do our home visits. We could leave our front door open in the hope that the cortically atrophied will randomly stumble in and then be unable to find their way out. We could check empty rooms and cupboards. We could look under rocks.

We know there are dements out there. And we are coming for them, and our prevalence will rise and we will get the QOF points we deserve. I have been quickly minuting all this and, at last, I pause and look up at my colleagues who have been enthusiastically and breathlessly churning out these ideas, and continue to do so. I note that they have the distracted, wild-eyed and not entirely healthy look that, in patients, always prompts me to ask whether they drive. And I think, blimey, I’ve found some already.