Letter: Quality framework skews patient care

Dear Editor

We have recently completed a six-week primary care placement where we participated in a chronic disease management task as part of the assessment.

As a change to previous years we were instructed to choose a chronic disease that was not part of the quality framework.

As part of the assignment we had to speak to three patients and also all members of the team involved in their treatment ranging from receptionists, nurses, other therapists and the GPs. We then had to meet in small groups with a facilitator and discuss our experiences.

The theme that kept appearing was the detrimental affect that the quality framework was having. When a disease is not incorporated into it, it seems to be swept aside and deemed not as important. Surely this is not the desired effect.

Guidelines still exist for these diseases but if they are not linked to points, and therefore money, there is no interest in them at all. Patients' care was not seriously compromised but there seemed to be a lack of understanding of and interest in conditions, such as Parkinson's and lower back pain.

Another student told us of a practice nurse, at the centre where she was placed, who rang patients to ask if they smoked. Surely there must be more important nursing jobs to address.

The emphasis on deadlines linked to monetary incentives in primary care is evident in many areas and is on ethically shaky ground. For example, depression is prioritised over arthritis, despite the fact that both are debilitating illnesses that have great impacts on a patient's quality of life.

A large amount of money is being expended upon summarising medical records before the quality framework deadline. While this is an important long-term goal, there are other important areas in which this money could be spent.

This government initiative is shaping the future of general practice but not necessarily in the right way.

Two medical students, names and addresses supplied.

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