QOF 'damaging patient-centred care', study finds

QOF is forcing GPs to marginalise patients' needs in consultations in favour of 'tick-box' targets, research has shown.

Consultations have become too focused on QOF, researchers say
Consultations have become too focused on QOF, researchers say

Routine consultations for patients with long-term conditions are now focused around the demands of QOF rather than being responsive to patients' concerns and problems, the study found.

It suggests, as many GPs suspect, that QOF may be causing doctors to miss important cues that could affect patients' health by pursuing strict biomedical targets instead of holistic care.

Researchers said government policy was pushing 'managerial values' onto general practice, leading GPs to treat patients as 'biomedical problems' rather than people.

The findings will bolster critics of the framework, which has been repeatedly attacked for increasing bureaucracy in general practice.

Writing in the journal BMC Family Practice, researchers from several UK universities said action was needed to dispel the 'tension' between evidence-based and patient-centred care.

They said longer consultations and greater continuity of care could help to achieve this.

Researchers reviewed 88 audio recordings of routine review consultations by GPs or practice nurses for 34 patients at six practices in north-west England.

All patients had either asthma, diabetes, CHD or COPD.

The researchers then interviewed patients and health professionals about how the consultations went within two weeks, followed by a further round of patient interviews three months later.

They found that patient concerns raised during the consultation were often 'missed or disregarded' by GPs, with appointments 'focused on delivering QOF', which 'dictated the talk... and shaped the consultation'.

Person-centred care 'in retreat'
GPs switched the focus away from the QOF on two occasions, when patients in the study presented with issues about cancer and a recent bereavement.

However, practice nurses in the study were unwilling to go 'off-QOF', they said.

The authors wrote: 'GPs are no longer configuring themselves, or being configured, as concerned with people as psychosocial beings, only with them as biomedical problems (with some exceptions, such as the "mentally ill" and the "dying").

'A government policy agenda that strives to apply increasingly active managerial values to the NHS encourages this retreat by GPs to a more purist biomedical space.'

Researchers were more optimistic about the potential impact of biopsychosocial reviews for patients with depression, which are being considered for the QOF 2013/14.

GPs in Northern Ireland recently condemned the QOF as 'no longer in the best interests of patients' and called for a new, simplified programme.

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