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15 September 2011
Government rewards for meeting targets have divided GPs, with some saying that they lead to doctors being too concerned with box-ticking to tackle fully patients’ problems, new research says.
A School of Social Sciences s study has found that some GPs were concerned that the Quality and Outcomes Framework (QoF) got in the way during consultations, while others felt it was a helpful innovation.
The QoF was introduced in 2004 to reward practices that met targets such as measuring cholesterol regularly in patients with heart disease.
Dr Sara Macbride-Steward interviewed 32 GPs based in Wales the qualitative study and found that several felt the time taken fulfilling the QoF requirements made it harder to tackle all the issues raised by patients. During consultations reminders appear on GPs’ computers setting out various tasks to carry out.
Speaking about her findings at the British Sociological Association’s medical sociology conference at the University of Chester, Dr MacBride-Steward said: "There was some concern that the QoF was damaging to patient consultations and professional autonomy."
"GPs were concerned that by responding to and prioritising these reminders they risked neglecting their patients’ problems," she said. "This was against those who felt that the QoF produced efficiencies and protected against wastage."
One GP told her: "In your 10-minute appointment you need to prioritise and you’ve got your little reminders on your screen. I’m a box ticker, it’s very tempting to tick the boxes, and once or twice I’ve caught myself [thinking] ‘oh gosh, I’m not actually addressing what the patient actually came in for’."
But some GPs interviewed felt that the QoF was useful in ensuring that best practice was followed. One told her that it "helped emphasise the importance of meeting targets."
The money the QoF contract gave to practices if they met targets could compose up to 20 per cent of income for practices according to estimates, said Dr MacBride-Stewart. This extra income meant that GPs could afford to pass more routine tasks to nurses, health care assistants and practice managers in order to save time and give themselves a better work-life balance.
But, said Dr MacBride-Stewart, "the GPs expressed concern that delegation could add time or degrade a service as it often required more staff, more appointments and slowed patient progress through the clinic."
One GP told her: "You start delegating more and more things to, say, the practice nurses and you haven’t really checked whether they are competent to deal with it."
Not all of the GP’s felt this way. One told her: "You know we’ve got to make the most efficient use of resources and me seeing people just to check their blood pressure isn’t an efficient use of resources."
Despite the delegation, some GPs thought that the 10 minutes usually allotted for consultations wasn’t enough, and they often ran late. One GP said: "The patients are still putting up with what I would say as being ridiculous waits," and another said "In general practice you have, if you’re lucky, a 10- minute slot for patients and that’s it, and if you go over that, your waiting room queue is piling up."
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