What's the point?

A little nihilistic maybe as questions go but when applied to QOF it would be nice to think that all this effort is doing the patients good. After all paying GPs and keeping administrators gainfully employed is all very well but it would be nice to think that it was actually achieving some health outcome.

Well there is, as yet, very little evidence of actual improvements in patients outcomes and at least some evidence of very little improvement. It is simply too early to say for sure. An article in this weeks BMJ (subscription required outside of NHS) goes rather further and suggests that harm may actually coming about because of the targets.

The quality and outcomes framework diminishes the responsibility of doctors to think, to the potential detriment of patients, and encourages a focus on points scored, threshold met, and income generated.

Pretty severe stuff but it is a feeling anecdotally shared by a reasonable number of GPs and indeed some patients (not suitable for those offended by swearing). Indeed there are quite a number of points made that I would broadly agree with. There are weaknesses in the approach of QOF, in particular in the application of treatment to groups rather than individual circumstance, although that is a problem Evidence Based Medicine has been struggling with for years - although to describe the QOF as fully evidence based is to rather push the definition.

This debate has some time to run.

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