Dr Phil Hammond, broadcaster and GP returner in Bristol

Are you tackling the QOF properly? There have been some suggestions that the system is open to abuse, allowing GPs to claim money that they aren’t entitled to.

Alas, no one is ever likely to discover if this is true because the Government has already paraded the QOF figures as “evidence” that general practice is getting better and the extra funding going into the NHS has been money well spent.

But at least there’s an attempt to improve quality. The consultants’ contract has been a complete disaster because the NHS has paid a lot more money for doctors to work to rule without any performance management,and has still succeeded in hacking them off.

So, how can you spot if a practice really earned those QOF points? Chances are, they were doing best practice long before the new contract came in, and so it wasn’t too much of a cultural shift.

However, they still would have had to pay for extra staff and training to collect and input data, and therefore, the likelihood is their profits aren’t nearly as great as some have suggested.

Computer programs are now being developed to spot those practices whose blood pressures always come in 2 mmHg below target whatever the circumstances.

But perhaps the best way of proving that your efforts have been worthwhile is to invite independent scrutiny to validate your work. This desire to know you’re making a difference to patients probably accounts for the increasing popularity of the Guidelines in Practice Awards.

The Awards recognise innovative schemes to implement national evidence-based guidance and raise standards of patient care. This year saw a record number of entries, perhaps encouraged by past winners. They found that the Award had not only brought local recognition, but also, in some cases, the recurrent funding from the PCT, which can be so hard to get in non-sexy areas like stroke, COPD, epilepsy and mental illness.

Most of the entrants believed the focus on evidence-based medicine had allowed them to improve care and they were all keen to demonstrate that, far from just jumping through the hoops, they had actually had a big impact on patients’ lives.

My favourite entry this year was ‘Falling falls in Falkirk’, winner of the older people category and joint runner up in the overall Guidelines in Practice Award. A team from the town council and Falkirk Royal Infirmary had not just come up with a falls assessment tool, but had also put a management scheme in place that demonstrably reduced falls (and the trauma and death that often accompanies them).

Local GPs love the service. I suspect this is because we GPs have never been great with falls, and we feel guilty that our incessant drive to get blood pressure down is making the elderly more wobbly.

Falls aren’t sexy, but I hope the award-winning clinic secures long term funding. If it doesn’t, they should calculate the money saved in the local trauma service by reducing falls and claim it back.

We’re supposed to suck money out of hospitals and put it back into the community, but these days you need hard evidence to get the local PCT to cough up. GPs may be paid for processes, but it’s the outcomes that really matter.

Guidelines in Practice, November 2005, Volume 8(11)
© 2005 MGP Ltd
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