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by Val Hempsey
31 January 2012

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Heads in the QOF?

Financial incentives and QOF deadlines have left practices frustrated they lack the time to deal with pressing patient issues, says Val Hempsey, a member of the Practice Management Network steering group…

Is anyone else as frustrated as me at the inane and thoughtless timetabling of all these different deadlines we have to meet?

We were already late in starting Quality and Productivity (QP) indicators 1-5, 6-8, 9-11 (June 2011 instead of April, as the detail was not published) and although the guidance says some indicators do not have to be in until the end of March 2012 they don’t really mean that – QP 5, 8 and 11 really should have been in by last week (w/e 27 January), at least in order to make any difference to commissioning intentions and plans for 2012/13.

Then there are all the different incentive schemes, with mind-boggling variations and dates. Who decides these stupid dates that we all work like frenzy to meet because it’s our income? God help us if they start putting the pressure on re the Patient Participation DES, 5% Counter Fraud, QOF assessment and anything else that’s somebody’s one and only job. Get with it, it’s not ours – we see and offer a service to patients as well. Or did they forget that?

I would have argued that my personal frustration is because I am disorganised and because I have just decanted a whole building into four rooms and a Portakabin because we are being refurbished. However, the cries of anguish are coming from my colleagues all over primary care, and some of them are well sorted and live in beautiful bright buildings.

I would also concede defeat if I thought all of this tail-chasing was really making a difference to the clinical outcomes of our patients and we were really saving lives or making a massive difference to the quality of our patients lives, but I cannot see it.

High-quality patient care has always been our main driver. But attending peer reviews with colleagues and telling them we are going to work harder on generic statins (which we were doing anyway) and haven’t we done well with our treatment of heart-failure patients and their bundles of treatments and increased our CHADs scores is not really allowing me to get on with the real work to be done.

I feel we are spending far too much time looking back and reviewing past work and spending inordinate amounts of time looking to blame ‘someone or something’ that we are not looking forward and saying: “From today, let’s do it a bit different.”

I know I am just moaning, but even if a few bad apples will not play the game and insist on doing their own thing unilaterally there must be a better way than having us all jumping through hoops to be seen to be ‘fair and equal’.

There is no such thing as equality, there are those that have and those that don’t, those that do and those that don’t, those that will and those that won’t. Patients are not equal, everyone is different so let’s not pretend but let’s get on with today’s work today.

Ramble over till the next time.

Your comments (terms and conditions apply):

“Yep I agree. However moaning isn’t going to make it go away and especially with the introduction of CCGs every department is asking for one audit or another by the end of the week. I think what would be more useful is for a Practice Manager to be involved in CCG so that they can restrict the amount of useless information required or any money saved in auditing will only be spent in PM’s time off with stress, or admin support when it could be spent on GPs and Nurses” – Jenny Webster, Oldham

“This is not a rant it is stating the obvious which every GP practice knows and is suffering, not just now but over the past years. Shrinking income with more data required monthly by the PCO. The structure of GP surgeries was never meant for this extreme of administration it was always intended for patient care” – John Holmes, Warwickshire

“Thank you Val for voicing all our feelings. Every practice manager I speak to recently is feeling that the job is being made so difficult by all the changes that are being imposed on us. Everyone is trying so hard to meet the targets and get on with the day to day running of the business as well and make sure everything is running smoothly with the patients – who are actually quite important in all this!! The practice managers i know are avery hardworking bunch of people and will do their utmost to get the job done as well as they can, but lately the odds have been stacked against all of us. Let’s hope 2012-2013 will be less fraught – but somehow I suspect not (and i used to be an optimist)” – Ann M, West Yorkshire

“Dear Val, thank God for the voice of reason! For a long time I have been saying to everybody who will listen – “what about the patients”? Patients and what they actually want seem to have been forgotten by this government. Most patients would be absolutely horrified that their doctor has to spend so much time on non-clinical bureaucracy. I keep saying to anybody who will listen that doctors are still trying to do the job that they were doing when the NHS was created but that the reason the rest of us on the administration and management side have jobs is because of all the bureaucracy that has been piled on ever since! God knows where we are going with the latest round of changes they want to implement. Never have I felt so worried about the future of the NHS” – Julie Lund, York

“I thoroughly agree with Val! I am drowning in target driven returns, buried in outpatient activity and emergency admissions data (which is probably flawed anyway!), trying to keep all our leaflets, notices, websites in synch so they all say the same thing at the same time and delving into the minutiae of patient records to find lost QOF points! Do I feel I am giving good value for money to our patients, my employers or my staff – No I don’t! Practice Managers should unite with one voice to put a stop to this pointless ever increasing tail chasing exercise” – Kay Boucker, Tenbury Wells

“Well said Val, I feel like we are in a “paint by number” nhs system with our patients, one size does not fit all, our Doctors became Doctors to practise medicine on human beings not act like acountants for the government. I am a Practice Manager for a small rural dispensing practice 3.5K patients, as such I have to multi task (dispense, phlebotomy as well as Practice Manage) I don’t have a team of administrators to do audits and constant daily reports full of mundane figures that do not actually make any clinical difference to our patients. Our patients don’t want more choice they want an NHS where they come to their caring Doctor, who in turn can give them medication that they need, and refer them on if they need. We seem to be dictated to continually,what we can or cannot prescribe and who we can or cannot refer. Soon we will not need people to run the NHS or Surgeries but a computer programme that ‘says no” – Name and address withheld

“I agree totally with Val. There are more ways to run patient care than follow this hugely bureaucratic system of returns.  Whoever agreed QPs6-11 clearly has no idea how practices work to improve referals and reduce emergency admissions. We do it by individual case management, which just does not fit stovepiping patients into single disease pathways – but we have to to get the money we have earnt another way. Can we not put PM input into QOF to make it more realistic?” – Alasdair Wilson, Southwold

“The problem also occurs with QoF – the indicators begin in April (and as they cover 15/12 from the following March, effectively many began last January). Yet the QoF tools for the clinical systems are not made available until late Autumn. The system appears unfit for purpose and should not run in this manner” – Stephen Humphreys, Herts