Treating by targets means GPs are encouraged to treat patients with similar diagnoses the same, even though resultant outcomes could differ, say authors of an opinion piece in the BMJ.
Evidence-based medicine is at the core of the quality framework, but this standardises treatments and is not a substitute for clinical judgement, they say.
‘Interventions become routine, and practitioners are no longer required to grapple with the innate uncertainties of each clinical situation,’ notes the team, led by north London GP Dr Iona Heath.
Moreover, rather than address health inequalities, the quality framework worsens them.
The most marginalised people often have physical and mental health problems, making them difficult to squeeze into the rigorous structure of the framework, they argue. Similarly, the poorest are most likely to have comorbidities.
Both these factors increase the likelihood of being exception reported, putting them ‘at risk of receiving proportionally less attention’ from GPs, notes the team.
Additionally, GPs working in poor areas are less likely to meet targets and therefore more likely to be poorly paid.
All of this means lower levels of healthcare for the people with the greatest needs, point out Dr Heath and colleagues.
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