Letters, calls and emails: Quality framework is turning upon us

Dear Editor

Well at least GPs know where they stand now, but why has it taken so long for the penny to drop (‘GPs on 600 points face PCT takeover’, GP 6 October)?

And where oh where was the forthright rebuttal we expected from our negotiators?

Philosophy in a moment, but is it legal for PCTs to put practices out to tender, based on performance in a structure that was originally designed to ensure that we got paid for high-quality continuing care in a limited number of areas of practice? And voluntarily, at that?

Consider: if I decide that care of the elderly, the mentally ill and those with complex physical,psychological or social problems takes precedence over the quality framework stuff, and proceed to target my time accordingly, how can a primary care organisation (PCO) claim that I am performing poorly?

And how would the medical office holders in that PCO feel if I then complained to the GMC about them? Would Dr Mo Dewji be happy defending himself?

Now the philosophy: what is quality? Better men than I — Robert Pirsig and Ahmed Risk — have devoted time to that question and I don’t think we have a simple definition that we can use in practice. Most of us know it when we see it but how to find it, that’s the problem.

So too with the quality framework structure, which really has very little to do with overall quality and has more to do with payment for work done. A cumbersome way of paying GPs, just like the monthly scrip is a cumbersome way of paying pharmacists.

Hence, and totally logically, it is seriously wrong to attempt to relate quality of practice with points scored. But we should have known the bureaucrats would try this one; they need sticks to beat us with, and they cannot understand any indicator of good practice that does not fit on a spreadsheet.

Dr Declan Fox
Newtownstewart, County Tyrone

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