2 Responses to “Inside Health”

  1. rillarevolution February 23, 2012 at 11:44 am #

    I think even more concerning than the straightforward QOF targets (though I definitely have my concerns regarding them) are the raft of additional targets that are around. Prescribing targets can cause patients to change medication year after year, where concordance is threatened as broad categories of drugs are treated as interchangeable and patients aren’t allowed to be individuals as side effects are belittled. I’m particularly concerned about the focus on referrals and admissions. With very little evidence base these initiatives seem to be based on the fact that there is a variety of frequency of referrals, therefore this should be equalised and of course, it should be equalised down the way. Less referrals = good doctor. No consideration is given to the patient demographics, the reasons for referral, any specialist interests the GP may have (which may actually lead to an increase in referrals in that speciality), the availability of other services (for example the dearth of a prompt physiotherapy service leading to a rise in musculoskeletal referrals). I am keen to practice medicine that is evidence based for the patients I care for, but in these areas there is unclear evidence and so to use the evidence based guise of QOF and DESs to affect clinical judgement to cut costs is irksome at best, and dangerous at worst. I do not like consulting with a politician on my shoulder, particularly when it comes to emergency admissions. It is also interesting to compare this year’s focus on decreasing referrals and admissions to the focus several years ago on reviewing all cancer diagnoses – the outcome of most of these was to suggest that we should have been referring more often and earlier.

  2. Margaret McCartney
    margaretmccartney February 23, 2012 at 2:32 pm #

    completely agree. I’ve been to several meetings recently where it’s been a foregone conclusion that GPs are overreferring. It’s quite crazy.