QOF 'no longer in best interests of patients'

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

Dr Arnie McDowell: QOF tail is wagging the general practice dog (photo: Jason Heath Lancy)
Dr Arnie McDowell: QOF tail is wagging the general practice dog (photo: Jason Heath Lancy)

Delegates to the annual LMCs’ conference in Northern Ireland on 14 April backed a motion declaring they no longer believed QOF was evidence based.

Dr Rachel Mackenzie of Eastern LMC said she was had been a ‘very big fan of QOF’ but it had gradually changed with an increasing number of indicators.

Dr Mackenzie said QOF now interfered with care.

The Francis report showed that targets skew priorities away from patients and kill, she said. ‘QOF is all about counting and not at all about what counts’.

Dr Tom Black, chair of GPC Northern Ireland said an ‘awful lot of effort goes into to trying to keep QOF sensible’, and the GPC was happy with the sentiment of the motion.

A second motion passed said while QOF had been successful in raising clinical standards, it had become increasingly complex and bureaucratic, promoting a ‘tick-box culture to the detriment of patient-focused care’.

The motion called on the health departments to negotiate with GPC for a revised QOF based on simplicity, clarity and evidence.

Dr Arnie McDowell from Southern LMC said there were many examples of QOF supporting good, structured care, such as in diabetes. But the two motions were indicative of the feeling among GPs that ‘the QOF tail is wagging the general practice dog’.

He said there was no intention to denigrate the GPC negotiators for their work in trying to prevent QOF becoming increasingly complex.

Dr McDowell said: ‘The time I realised QOF had lost the run of itself was when we were really struggling in the practice for osteoporosis points because we didn’t have an over-75 patient who’d had a fracture in the past year.

'My junior partner sent me a text that one of our little old ladies had fallen over and broken her wrist and so it was "problem solved". And both of us thought, "is this what we have come to?".'

He added: ‘This motion is sending a message that QOF is disproportionately complex and disproportionately intrusive.'

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