We’ve turned our GPS into bean counters
‘The QOF is a disaster, measuring the measurable but ignoring the immeasurable’
Many readers may not know or, indeed, be shocked to learn, that over the past 13 years, their family doctor has been “paid for performance” – financially incentivised to diagnose as many of their patients as possible as having diabetes, raised blood pressure and a slew of other conditions, and to prescribe them lots of pills.
This is, for any number of reasons, a bad idea, exposing the public to the hazards of overdiagnosis and overtreatment. It also distracts family doctors from their prime task of providing “continuity of care”, being sympathetic and taking the time to engage their patients in conversation, find out what is amiss and hopefully put it right.
The Quality and Outcomes Framework (QOF) has cost a staggering £25billion, and although it was originally claimed it would “raise standards” so everyone would be healthier, “saving” 30,000 lives a year (and similar nonsense), there is not the slight scintilla of evidence that it has done so.
It is also tedious beyond belief, mind-bogglingly bureaucratic and time-consuming, with GPS having to spend a day or more a week just ticking the necessary boxes. It is thus one of the several reasons why, frustratingly, it can take up to a fortnight to get an appointment at the surgery.
Anyhow, the important point is that it is widely seen as a serious mistake – or, as the leading architects of the scheme put it euphemistically in the British Medical Journal last week: “It has resulted in some benefits and caused some harm.”
Dr Des Spence, a Glasgow GP, puts it more forcibly: “The QOF is a disaster, measuring the measurable but ignoring the all-important immeasurable, squandering our time, efforts and money. It has made patients of us all and turned skilled clinicians into bean counters.”
The quandary remains as to what to replace it with, as its abolition would result in GPS losing up to a quarter of their income. But, in the meantime, it is reasonable for people to inquire whether they really do have all those conditions their family doctors have been financially incentivised to diagnose, or do they need to take all those pills they have been been prescribed?
Waking up with flu
This week’s medical query comes courtesy of Mrs KL from Kent, writing on behalf of her husband. For several years now, he has woken in the middle of the night and early morning “feeling as if he has the flu”, with aches and pains, feverish and generally unwell. He improves as the day progresses and he gets moving. The usual blood tests and MRI scans have revealed “no obvious problem”. He is otherwise well, besides having raised blood pressure controlled by medication. Any suggestions “would be much appreciated”.
Less-friendly service
Finally, there is more to the marked fall-off in the number of blood donors – down by almost a third over the past 10 years – than I appreciated. Several veterans who have proudly provided 50 or more units of blood over the years report the blood transfusion service has become less volunteer-friendly.
It has, for example, imposed an upper age limit of 70, and an inefficient appointment system “where an optimistic time frame for donations is assumed”, so it is not unusual at busy times to have to hang around for an hour or more to be bled. A long-standing donor from Dublin recalls that back in the Sixties he was entitled to receive either a cup of tea or pint of Guinness. He regrets this latter incentive has subsequently been withdrawn.