Editorial: What GP life would be like without QOF

Last month GP argued that 'A scaled-back QOF would cut GP stress' (GP, 19 August) and on pages 35 and 36 in this issue, our analysis asks: 'Has QOF reached a dead end?'

Much has changed since the Red Book was shelved and QOF was introduced to primary care, alongside what was then referred to as the new GMS contract of 2004.

It is entirely feasible to imagine that a decade and five health secretaries later, current incumbent Jeremy Hunt would be wishing to cut back on target culture that 'gets in the way of the personal relationship between doctor and patient'.

Less so that GPC deputy chairman Dr Richard Vautrey would describe QOF as 'too much of a micromanagement tool' or that his chairman, Dr Chaand Nagpaul, would back downsizing, although not scrapping, QOF, with more funding transferred to core pay.

What GPs who are suffering because of the growth of tick-box medicine will be keen to know is, how will they be affected if QOF is scaled back or, whisper it, axed? Even a QOF expert, Wiltshire GP Dr Gavin Jamie, suggests that it has become 'a bit desperate' and 300 points might now be more appropriate.

Elsewhere, Manchester GP Professor Carolyn Chew-Graham has found QOF in its current form is not well suited to directing care for patients with multiple long-term conditions, and a BMJ paper earlier this year suggested the improvements delivered by QOF could have been achieved with smaller incentives.

Here at GP we're expecting something bold and a big idea from recently elected GPC chairman Dr Nagpaul as new GP contract negotiations begin and while it's unlikely to be as radical as wholesale axing of QOF, the ramifications of doing so should be considered by both sides.

What would GP life without QOF look like? How did patients fare before its introduction and how might they be affected by its junking?

The big problems facing the profession, intensifying in recent years, deserve nothing less than the full investigation of all possible solutions, however radical they may at first appear.

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