Dr David Turner welcomes the reduction of QOF as the end of tick-box culture in general practice
As we count down to QOF year-end, we are once again reminded how the law of diminishing returns works. Repeated phone calls to the reluctant attenders to ‘please book in for your annual BP check/foot check/mental health annual review/smear’, are frequently met by an unanswered phone, a reluctant agreement to attend which will never materialise or a flat refusal.
We rarely get time to sit back and reflect: How did it ever come to this?
The 2004 GP contract was supposed to reward practices for achieving quality targets. But instead, for many, it ended up financially penalising practices that miss target by a few percentage points – not because the practice staff are not working their backsides off, but because some patients simply do not want the care we are offering.
Why should practices earn less because some patients (who are well within their rights to do so) choose to not engage with the monitoring/checks/immunisation or screening we offer? If patients are competent and informed and they choose not to vaccinate their children – an idiotic decision in my view, but one which they are entitled to make – why should GP partners be out of pocket for this?
To be honest, I can see why some patients don’t want to ‘comply’ with our calls for QOF and ECF box ticking. Take the mental health ECF for example. It requires us to ask if patients are sexually active. What business is that of mine? Unless a patient is presenting with a sexually transmitted infection, why is it my business what they get up to just because they happen to be on a register for mental illness. Bear in mind that some of these patients have been well and stable for many years; they have busy lives and don’t have time to spend with me asking them how much they drink, or what they get up to at the weekend.
As I work through lists of patients ineligible for aspirin, statins or further tightening of their blood pressure, it strikes me just how pointless this is. They were not eligible this year and they won’t be next year either. And, if they do become so by any chance, I will have already actioned it and don’t need some idiotic check list to remind me how to do my job.
I was glad to hear the mood music from the DSHC is to reduce box ticking and along with the announcement of the abolishment of the NHSE, as welcome as an ice bar in the Sahara, it seems finally there has been an outbreak of common sense at the DHSC.
Now you have started, Wes, keep going with this. You can tick it off your list then.
Dr David Turner is a GP in Hertfordshire
