Chris Lancelot - Misleading targets will send practices off the road

A rally driver has to travel two miles at an average speed of 60mph. He covers the first mile at 30mph. How fast must he take the second mile in order to achieve his target?

The GP Record, by Fran Orford

The intuitive response is '90mph', but this is wrong. Covering two miles at 60mph takes two minutes - but our driver has already taken two minutes to complete the first mile. It is now impossible to average 60mph over the whole distance, however fast he drives.

This is just like present-day general practice. Increasingly GPs are being given targets which at first seem sensible, but when looked at in detail turn out to be almost impossible.

In principle the QOF was a good idea, because it rewarded good practice. But it has now become too complex for its own good - indeed, so convoluted that organisations regularly hold lectures on how to satisfy each year's new rules. Everyone experiences problems over patients who should (but don't) hit the targets for one reason or another. And then the DoH 'refines' the rules again, often just before the closing date.

The quality and productivity (QP) indicators are even worse. It should be simple to achieve these - just improve your prescribing and referring. But what about those practices which already prescribe and refer carefully? In order to continue receiving a sizeable chunk of their current income they may be gulled into accepting a referral reduction or prescribing target which looks innocuous ... until, like the rally driver, they discover that it's impossible. Then they lose all the money from these sources.

There are some serious truths here. QOF can account for up to a third of a practice's income. That's gross income, by the way, not profit: take away a significant slice of QOF, DES and LES income and many practices won't just experience reduced drawings, they'll go bankrupt. Quality payments are no longer the icing on the cake but part of the cake itself.

So beware: 'Slightly tightened targets' and 'redistributed points' can destabilise practices financially, especially when they involve large numbers of points and require year-on-year betterment. High-quality practices are potentially more vulnerable because they are already efficient and cannot easily deliver further improvements.

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