Re: Quality improvement in primary care

Dear Editor

Timely, informative and useful article; thank you! Looking for solutions to the workforce crisis includes being prepared to minimise unnecessary work. I haven’t seen any evaluations of the impact of QOF on GPs’ workload, demand for appointments, or benefit v harms to patients.

Nearly twenty years on, we can be pretty certain that QOF is nigh-on useless for its intended purpose. No heath outcomes improved, lives saved, hospital admissions avoided, or urgent care need reduced. QOF was useful in helping to drive equality of practice to a standard across the board, but it may not have driven quality anywhere. Data still needs to be collected but the question is what and how often.

GPs work well with professionally peer led CEGs (Clinical Effectiveness Groups) who, given a half-decent IT system, can together arrange QI categorisation, collection, and recall/review pathways, where this is likely to improve care. Quality markers and systems should be professionally developed and run (how it was before the machine took over), not as pay-for-performance measures, which consume inordinate amounts of Practice time and resources, and warp medical practice against the evidence.

The evidence-based approach would require NHS England to follow Scotland’s example, lol. The second reason that NHSE won’t drop QOF (and PCN DES) is that pay-for-performance is a major corporate lever for control.

Parameters that comprise QOF are derived from studies that apply to populations, and treatments have NNTs, which must be factored into the over-medicalisation and over-investigation of large numbers of individual patients inherent in the pay-for-performance, managed-care regime.

It is time that GPs reclaimed their time: time to devote to patients in ways we already know matter to them and to their health outcomes.

Dropping QOF and DES would free up Practice time and capacity, and may ameliorate the current GP workforce crisis.