Wednesday, September 22, 2010

Asthma: Hookworm or QOF

As recent research dashed all hope that hookworm may help to reduce the incidence of Asthma, there may indeed be a simpler way: QOF or abandoning QOF

Doctors 'over-diagnose’
By Martin Edwards
20 Sep 2010

........The answer, unsurprisingly, involves money. The most recent contract between the NHS and GPs incorporates something grandly called the Quality and Outcomes Framework (QOF), which aims to reward GPs financially for good clinical practice. Under a complex and arcane formula, the more patients we diagnose with and treat for certain disorders, the harder we are deemed to be working, and the more income our practice attracts. Working in misery-soaked south London, we were staggered to discover that the prevalence of depression among our patients was far lower than expected, taking account of factors like class and income.

These regulations apply to all NHS GPs and this over-diagnosis is not limited to depression. Some children, and a few adults, develop a wheezy chest when they catch a cold. However, we only get money if we diagnose asthma, a label that might well follow a child through school and into employment. And that single entry of “raised blood pressure”, often occasioned by a last-minute dash to the surgery, is sufficient to label you as hypertensive. Each of these labels can affect insurance, mortgage, loan or employment prospects.......
                                                                                    Read all: The Telegraph
Jobbing Doctor in a recent re-posting:

There are certain outcomes that have occurred as a result.

Firstly, Government underestimated the amount of high quality medicine taking place in primary care at that time, and so did not budget for it (despite being told repeatedly). This saw GP income increase by around 33%. Practices like mine had no difficulty in hitting the targets - we were there, pretty much, already.

Secondly, performance measures were always a very crude measure of clinical excellence, and therefore - as a valid measuring tool - had significant flaws. I have seen this.

Thirdly, it encouraged gaming with the system. Some GPs, whose practice income depended on hitting targets, would be tempted to distort the measures and also (on occasions) invent data. I have seen this happen in my locality (but not in my practice).

Fourthly, the focus would be on conditions in the QoF areas and other conditions - outside this system - may well get less attention.

Money distorts!!!



Anonymous said...

I was all set to get to India to get hookworm.

Thanks C.C.

Doctor Zorro said...

Overdiagnosis and unnecessary treatment are common. I have seen children taken to the GP, and referred on to paediatricians because they get short of breath on exercise. Instead of being told that that is supposed to happen they get given inhalers.

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