Tuesday, 20 October 2009

What makes a perfect patient?

A quick bit on GP funding before we begin so you know what I am talking about in the future - QOF stands for Quality Outcomes Framework - its a points based system for GP funding. You get points for managing certain conditions, managerial activities and other things. For example for a patient with heart disease you would get points for checking they are not depressed, on certain medication, blood pressure is below a certain value etc... Its designed to increase the level of care a patient receives by ensuring certain targets are met. It does mean that there is a tendency to concentrate on getting the points and nothing else however. Also some points are based on dubious targets or near impossible to get (the recent biased and poorly designed patient questionnaire released by the government was a good example). We have a few nurses who's sole job is to go chasing QOF targets to make sure we score as many points as possible

In exchange for not doing out-of-hours care anymore GPs had a paycut of about £6000, QOF targets were also introduced. At the time there was a recruitment crisis in General Practice so the government hoped getting rid of Out-of-hours care for GPs would make it more family friendly and changing the funding would raise pay a bit. When the QOF targets first appeared the government assumed most GP practices would reach about 70-80% of the total. Infact most Practices got 100% so received a bumper amount of funding. This is why Partners salary went shooting up. It wasn't that they were greedy it was that they were doing their job well!

The government ever since has been trying to claw back some of this funding ever since by changing targets on a yearly basis or forcing GPs to do extended hours again without giving them back the original money they took from them. There has also been a smear campaign against GPs as the government was more than a little embarrassed at cocking up the GP contract negotiations and giving too much funding to General Practice. QOF targets have had negative and positive impacts on General Practice, I'll talk about them more in the coming months but that was just a brief run through to bring you up to speed. Any questions send me a tweet via @GPforhire on twitter.

(below is taken from my blog on Pulse)

Its fairly easy to find out what makes a good GP – for example the GMC has some good information on it, as does the RCGP. But what about patients? What makes a good, or even a perfect patient?
I guess it depends on you want out of them, at its most basic could the perfect patient be the one who is registered but never turns up and lives a happy healthy lifestyle with no need for a GPs input? Perhaps but with my QOF chasing hat on you can’t score that many points from them. Maybe a few points as they are a non-smoker, non-drinker and normotensive. But not many.
Perhaps if they had a few chronic diseases that would be better, could get a few more points out of them. What about if they are a depressed obese asthmatic with epilepsy, diabetes and heart disease? Could score a lot of points there! But to be a good patient they would, of course, have to turn up for regular review and take all the medication you throw at them. Ideally you want to be able to score as many points for as little work as possible I suppose. Maybe patients could be trained to chase their own QOF points? What if a cohort of diabetic patients touted their QOF point potential to low-scoring practices? Could they hire themselves out by registering with a different practice each year?
You could have some sort of QOF ├╝ber-patient but it’s just a tad dehumanising to only view them for their QOF scoring potential. For me personally I like patients who turn up on time, don’t stink of fags, booze or sweat, don’t have a vast list for me to try and sort out in 10mins, do what they are told, and most importantly send me cards saying thank you so I can put them in my appraisal portfolio to show what a wonderful doctor I am as it seems nowadays if its not written down it doesn’t count.


  1. "This is why Partners salary went shooting up. It wasn't that they were greedy it was that they were doing their job well!"

    A lot of these points are, as you say chased by the nurses and support staff.. pity our salaries didn't go up, or is it that the Dr is doing a good job at slave driving!?

  2. lol, yeah I know. I will do a blog/rant about distribution of QOF funding cash. its a whole topic in itself.