Chris Lancelot: QOF rule delays - cock-up or conspiracy?

Does the government take the QOF seriously? The fussy rules suggest they do - except that it's now April, and they still haven't released the detailed rule sets for the new QOF year.

One new target is for Pill users to receive advice about long-acting reversible contraception. Do we yet know with certainty which alternatives we have to mention, or precisely what 'receiving information from the practice' is supposed to entail? No, we don't.

To make things worse, the rules are becoming so complex - on smoking habits, for example - that it requires a computer to disentangle what we are supposed to do (and even then they can be self-contradictory). Yet until the detailed rule sets are released, software programmers cannot create the prompts reminding clinicians which QOF indicators are still outstanding.

How are we supposed to record our actions contemporaneously in the patient's computerised notes? Many rules require new Read codes to be recorded: they haven't been created, of course. (They might be there by October, if we're lucky. Alternatively, the rules themselves might change just before the end of the QOF year, as happened last February.)

In what other contractually binding venture would one party have to guess what needed to be done, speculate on how to record it, and then have to change every record retrospectively when new coding is introduced (and is this legal, anyway)?

There is a part of me that thinks this is a gigantic cock-up: that the DoH can't work out how to arrange a simple set of targets, issue a simple set of rules, and back them up with the necessary coding structure (whereas I reckon I could do it all in an afternoon on the back of a fag packet).

But another part of me says creating these rule sets is so easy that any delay or unnecessary complication has to be an attempt to frustrate and demean GPs, and to minimise our pay by being difficult. How would the government respond if practices delivered their side of the contract with the same couldn't-care-less attitude?

The QOF is over-complex, late, unsupported by Read codes and outside contract law. It allegedly consists of 'modern' targets created by our 'efficiently managed' DoH. Are we supposed to laugh or cry?

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