QMAS overhaul feeds target culture

GPs fear plans to broaden the remit of the IT system that calculates QOF pay will fuel the rise of a 'target-driven culture' in general practice.

Dr David Jenner: worries about how evidence might be used by PCTs
Dr David Jenner: worries about how evidence might be used by PCTs

The DoH and NHS Connecting for Health (CfH) are considering replacing the quality management and analysis system (QMAS) with a system that monitors beyond QOF.

The replacement tool would also monitor directed and local enhanced services and other 'local quality indicators'. These may include targets proposed by NICE for the QOF, but rejected by negotiators.

Dr Grant Ingrams, co-chairman of the joint GPC/ RCGP IT committee, said PCTs could use the data to performance manage practices.

'The government is pushing towards the micromanagement of general practice and a target-driven culture,' he warned.

This would undermine patient care, said Dr Ingrams.

'If you introduce targets and make it really important that practices meet them, either for financial reward or because of the way it is portrayed in the press, then practices will put them above quality of care because that cannot be counted,' he added.

NHS Alliance GMS contract lead Dr David Jenner said: 'I worry about not knowing how the evidence might be used. It could be used for balanced scorecards or for an extra element of contract monitoring.'

Dr John Canning, chairman of the GPC contracts and performance subcommittee, said any system would need to be 'properly negotiated' because 'the devil will be in the detail'.

'If this will help practices achieve Care Quality Commission registration and accreditation then it is good. But if it's a top-down dictatorial approach then it is unhelpful,' he said.

GPC negotiator Dr Richard Vautrey said the new system could benefit practices by reducing the burden of multiple requests for information on conditions such as diabetes.

'The intention is that this would be used to manage those requests in a more sensible way so practices are no longer bombarded,' he said.

Dr Vautrey added that the GPC was involved in the process of changing the IT system.

A DoH spokesman said a contract with QMAS supplier BT was ending soon and this had prompted the review. CfH is surveying staff about QMAS until 9 November.

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