Q is for Quality…

Max is a little peeved.

For those of you who are not familiar with QOF, it is essentially Quality and Outcome Framework, well that’s what it stands for.   Pretty gargony admittedly. I could describe it as a set of targets that the government has put in place for GP surgeries to meet and get rewarded for.

Cynically I could tell you it is basically a juicy carrot, for cheap statistics to make the government look as if they have improved primary care. 

Even more cynically I could tell you it is a bunch of tick box targets with no real meat to it.

I think somewhere in the archives you’ll have found me going on about it before.   On occasions when targets are looking like they won’t be met my employers, they put me off regular appointments and let me bash out a few tick boxes, so they get the juicy carrot.  Last time this happened it was to get “x” number of patients with dementia reviewed. The first year they sent me to nursing homes, bit of a joke really.

The patient who need reviews and assessments are sitting at home, can’t remember who their elderly spouse is, and the elderly spouse is acting as a full time nurse despite being 82 and riddled with arthritis.  But they take too long to get to and the target needed meeting in 3 weeks, so the people who get the reviews are in purpose built care home with qualified carers.

The second year they tried to pull this stunt off…

I put my foot down metaphorically (I said no) and literally (I ended up driving house to house visiting those who really needed seeing). It was a hell of a task, nightmare to organise and very time consuming.  But I did it and I felt I had done something worthy.

This year we are running short of asthma reviews, normally these are covered by someone else, but she just can’t catch up, so Max has been asked to mop up the overspill.

OK so I am not an asthma specialist, but all I have to do is check their serial peak flows - (tick the box), inhaler technique (tick the box) and have a quick chat. The nurse that does most of them has 15 minute appointments, and if things aren’t good enough in the patients asthma management she immediately knows what needs changing. 

I have 10 minute appointments normally, so have doubled these when doing asthma reviews.  It gives me time to look at the asthma management step up table and make sure I am giving the patient the right change in management.

I have just be asked to put my appointment times back to 10 minutes as I am “doing too much” in my reviews.

Times like this I remember I am now an employee in a private business contracted by the NHS and not working directly for the NHS.  I don’t like it.  I’ve always had managers, but I used to feel I was working for the patient, but on occasions like this I feel like I’m working for a tosser with an expensive sports car.

I’ve been encouraged in the past to become self employed.  Sounds too much like stress to me but perhaps I should, or would I then just become a tosser trying to get an expensive sports car.