In 2004 the UK government introduced the Quality and Outcomes Framework (QoF) to reward practices that meet certain targets, such as measuring cholesterol regularly in patients with heart disease, however according to new research from Cardiff University, GPs seem divided in their opinion about the reward system. The system involves reminders appearing on GPs computers that set out various tasks during consultation, while some GPs regard the reward system as a helpful innovation, others fear it is distracting them from concentrating on their patients.
Dr Sara MacBride-Stewart conducted a qualitative study involving 32 GPs based in Wales and discovered that several GPs felt the time taken fulfilling the QoF requirements made it harder to tackle all the issues raised by patients.
She told the British Sociological Association's medical sociology conference at the University of Chester today:
"There was some concern that the QoF was damaging to patient consultations and professional autonomy," and carried on to say: "GPs were concerned that by responding to and prioritizing 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."
According to one GP that took part in her study:
"In your 10-minute appointment you need to prioritize 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'."
Some GPs interviewed considered the QoF to be useful in ensuring that best practice was followed, with one GP stating, "helped emphasize the importance of meeting targets."
Dr MacBride-Stewart stated that according to estimates, the money practices received from the QoF contract when meeting their targets could make up to 20 percent of income for practices. This additional income could offer GPs the financial means to hand over more routine tasks to nurses, health care assistants and practice managers saving time and achieving a better work-life balance.
However, Dr MacBride-Stewart said:
"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."
As one GP declared:
"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."
Some GPs had a different opinion. One told MacBride-Stewart:
"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."
Irrespective of assigning routine tasks to others, some GPs stated that the general allocated 10 minutes for consultations was insufficient and they often ran late. According to one GP: "The patients are still putting up with what I would say as being ridiculous waits," and another added, "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."
Petra Rattue