h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Ah yes - the government thinks healthcare is bad because doctors are evil and lazy, and setting them more paperwork will solve all the UK's health problems. Strange how there's a lack of targets aimed at stopping doctors from working too many hours or from generally going to pieces.

Never mind - good Entry

Thanks Alex. In my experience it is helping some doctors to improve what they do merely by being assessed by other GPs. But I'm not in favour of the extra paperwork involved.

As someone who has had to deal with QOF for the last year, I really can say it's probably wahat the majority of GPs were doing anyway- the only difference is now we are being recognised for it, so the Government have to pay us more. It is this that the begrudge.

In any case, you do not have to do QOF, ie code your work accordingly, but I guess it may appear bad. It can sometimes be a pain with all the codes.

QOF poits can be awarded from all manner of things, and I feel are good in that they promote good practice. There is some extra work to do of course, in getting your partners and all the staff involved, as well as protocols etc, but in the whole I think most practices have this.

I tell you, the UK should be damn grateful they've got on the whole a good Community based medical sevice. It's bloody cost efficient as well- it costs about £15 to see your GP, whereas £150- £300 to see a hospital consultant!!!Just look at America + see what a mess they are in!

Wattaray Bro

Wattaray Bro.

The idea of points meaning prizes was an improvement on the last "bright" idea of HMG ie "clinics". Some really daft ideas came out of that one.

The carrot and stick method really does seem to work with GPs. HMG however did not realise that it would go down so well. The estimates were that only about half the points would be scored by the end of the first year.

There are three main reasons why the system ran so well

a)The points were set for what was generally regarded as good practice so that most practices were setup to do the right things already. Their main work was to document most of it better.

b) Most practices are computerised so it was easy and quick to produce a list of (say) which asthmatics hadn't been checked on recently. How practices without computers checked through several thousand paper records I don't know.

c) Practice Managers and Practice Nurses were widespread and aware of how to run Asthma clinics, diabetic clinics and so on. They had protocols so it was easy to see if (for example) a blood pressure had been checked: there was a space for entering it quickly if caught in the passing too. They were able to produce quickly lists of folk to check.

HMG have recently produced a change in the points system just a few weeks before the cut off date for the annual review. Only a cynic would say that there were financial motives behind this move. Over the years mind you a lot of doctors have become cynical about certain moves by HMG

The Government wants to downplay the role of GPs, and say they are paid too much. Well, I don't know many jobs where you have to take on oath to do no harm to the patients under your care after you qualify from Medical school, then undertake further x years of postgraduate training passing numerous more exams, becoming a member of one of more of your respective Royal Colleges. Not only do you have to practice medicine +/or surgery but you have to manage risk, be a business manager as well as be completely unbiased. With all this in mind, the new challenge of QOF was mastered, because lets face it GPs are masters game.

My plumber earns more per hour than some GPs- I'd like to see him (or an MP)managing a sick child, on a Friday afternoon, whose parents don't want to take him to the hospital cos it's a scary enviroment. I used to be a plumber, and I tell you- life as a GP is not at all enviable. The goverment should pay GPs what they deserve.

Wattaray

The QOF year is coming to an end soon- (end of March)- if you go to your GP now, you'll get your BP, weight, waist measured, may well get some bloods + given diet + lifestyle advice+ if you have asthma, diabetes, COPD or some other chronic disease- you'll have that looked at too!!!

Like an MOT in a hurry then?

Yeah- pretty much! Its all to do with timing sadly- the QOF year ends on 31/3/10- so there's a mad scramble during the last few months to get as many unallocated points as possible- the points are how GP surgeries get a proportion of their funds.

guess its the same in any business really + it may mean the difference between paying the staff you've got or considering restucturing + getting rid of some!!!

the problem with QOF- that the Government want the public to know, is that it makes GP partners rich, whereas other GPs (salaried, miitary, locums) do not generally benefit from this.

The advantage that the Gov have is that they know, that most of the pulic think all GPs are partners (its clearly not the case)

Chances are if you make an emergency appt at your GPs, you will be most likely seen by a salaried GP or a locum

Wonder what will happen- following the arrival of the New Government???

I heard from a fellow medic that the Conservatives would consider removing targets for treatment and replacing them with 'outcomes'. Unfortunately, the example I heard was that hospitals would be penalised for having too many patients with cancer - something that is down to the incidence of the disease rather than the hospital's attempts to treat it.

GPs have been judged by outcomes for a while (QOF- quality-outcome scores).

Surgeons are too + mortality/ morbidity figures on individual surgeons can be accessed- its a controversial topic as undoubtedly, if you want to improve your figures- you take on less challenging cases!!

I suspect it's not always the hospital, or GP practice's fault- a lot depends on your population type- if you aere in a deprived part of the world, the standard of health + education + employment will be poorer than affluent areas!!- with increasing social deprivation comes more illness.

some responsibilty has to go to the patient to look after his/ her health- its not completely down to the clinician

A man arrives in a country he has never been to before. After he leaves the airport he develops a terrible pain in his side and realises he must find a doctor. He asks someone about where to find a doctor and they point him to Barley Street. That's where all the doctors hang out. The kind person also mentions that a doctor must fly a flag for every patient of theirs that has died.

The street is full of flags with many doctors having rows and rows of them. Then he sees an office with only one flag.

"That's the one for me!" he thinks and goes inside.

The doctor is very friendly and examines him.
"I must remove your appendix, urgently!" he says.
The traveller agrees and a few minutes later is lying on the table in a gown being given an anaesthetic. The last thing he hears before passing out is the doctor saying to the nurse, "I told you we would get a second patient!"

Very good- could technically happen!

So the new Goverment(s) finally bedded in + it looks like PCTs (Primary care Trusts ) are going to be gone by 2013 + Gps will be commisioners!!!- this could be good or bad if you are a doctor depending on your poit of view.

means a lyer of beuracracy will go + Gps can provide services that they know will effect their respective patient populations. I do wonder though- that some of doctors will be looking sadly to line their own pockets- oh well, thats always the way

What will this mean for preventative services - health promotion etc? I cannot see many GPs spending money on this rather than for services for patients who are already ill. Will it be done at a national level?

The money will come from a central body to commissioning groups of GPs, who will decide how to fund things locally. Of course there will be national campaigns (eg Flu vaccination,child immunisations, etc)- but I think most will be allocated at a more local level!!

I think hospitals will suffer myself- the community will prosper more perhaps......

We are into the flu vacc season- I myself must have vaccinated about 50 pts ad hoc as they come in for something else!!!- think our surgery is doing quite well + we should be finishing soon.

Lord knows what will happen re commisioning + this sort of behaviour!! May mean lots more clinics- anyways there will be a lot of jobs going from the PCT though (or they will be re-branded as something else perhaps with a huge payout)