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New bounty on smokers helps GPs balance their books

March 26th, 2013 Posted in health by

It is coming up to year end for GP practices and that of course means that they will all be diligently filling in reams of paperwork for the DH in order to secure maximum funding via the QOF. In the doctor’s business journal medeconomics Dr Gavin Jamie gives some top tips on how practices can maximise their points score.

According to Jamie:

It is that time of year when practices are polishing their data and preparing for the annual inspection on 31 March of their QOF achievement.

For many it is a matter of pride, and not simply financial necessity, to get the most points that they can. Here are my top tips.

The DH is now effectively offering GPs a bounty on every smoker they can identify and attempt to “reform”, so it is perhaps not surprising that third on his list of top tips for achieving the warm glow of satisfaction that only comes from a good dose of centralist bureaucracy is upping the practice’s smoking score.

TIP 3 Smoking

This has become more complicated with the need to offer smoking cessation advice or prescribe therapy to all smokers over age 15.

Due to the way that this is calculated, improved coding of people who have stopped smoking will enhance the advice indicator.

It really is worth making every contact count – even where patient just calls into reception or speaks to the practice by telephone.

If you are the sort of person who takes pride in this kind of exercise or if your practice just needs the money Dr Jamie recommends that you hassle people about their lifestyles at every possible opportunity.  I haven’t been anywhere near my practice because I am coming to hate the place. I wonder how many others feel the same and how long it will take for politicians to work out that this approach is counterproductive?

Surely even Dave can see that a system that encourages GPs to repeatedly annoy their patients is not a good thing. No doubt his DH advisors will claim to have “peer reviewed” evidence to the contrary and we can assume that it is the same advisors who tell him that minimum alcohol pricing will target alcoholics and that smoking bans have had dramatic immediate health effects. Surely at some point he will work out that these people are rather economical with the truth? Won’t he?

by Chris Oakley

This post is a followup to “The Department of Health is watching you!

7 Responses to “New bounty on smokers helps GPs balance their books”

  1. Jamie Williams Says:

    Just came across this (and your previous article). Thanks for bringing it to my attention, I had no idea this was happening. It is possibly one of the most idiotic and counter-productive ideas I have come across. I cannot even begin to imagine how this idea got off the ground. Is there anything that can be done to stop this ? Who is in charge ? Just astonished.


  2. Naomi G Says:

    WTF? What on earth is going on with this totalitarian minded government? I thought the Tory party was supposed to be “light touch” party and the Liberals should know better than this.

    This is NOT the role of doctors. I certainly hope that they will ignore the financial incentives and tell government where to stick their nannying.

    If this is truly a policy supported by the liberal party – a party then something has gone horribly wrong with it.


  3. Gasper Says:

    I read the last report and meant to say then that this is totally ghastly. If any doctor asks me how many cigarettes I smoke when I go in with a dodgy knee he/she will be told precisely where they can go. Same goes for how much I drink and what I eat. As it happens I don’t smoke. But if this is the NHS we are being forced to accept I’d prefer they sold it off, gave me my share of the cash and let me find my own health provider. Where will this end exactly.


  4. Chris Oakley Says:

    The QOF is an example of a completely out of control bureaucracy that no government dare tackle because moves to do so by any party would result in much public wailing and gnashing of teeth from the healthcare industry, not so much from front line staff as from the myriad managers and bureaucrats who vastly outnumber them.

    I do find it frustrating that more doctors don’t speak up in favour of a more humane, less statistics obsessed medical culture but we should not assume that they are all autocratic healthists. In researching QOF I read Kevin Hinkley, a GP from Aberdeen who writes a regular column for The Pulse

    Amongst other gems Kevin has written a piece titled If QOF seems illogical, it probably is in which he theorizes that the QOF was dreamed up by a bored homeless man from East Putney.

    My favourite paragraph is:

    “I now feel embarrassed that doctors up and down the land have slavishly followed QOF and I’m genuinely remorseful because most of it was written when I was completely smacked off my tits. I want doctors to remember that if QOF seems illogical then it probably is, and there’s a very good reason for it. It was written by a man who drinks meths and lives with a dead dog.”

    The explanation is about as good as any other. Nobody seems to actually own this glorified tick box exercise in central planning and control although it does keep an awful lot of people very busy. It is of course rather soul destroying and somewhat Orwellian so it is nice to know that not all doctors have lost their sense of humour.


  5. Gasper Says:

    Surely the time has come – especially as Govt looks for further savings – to say that it is time that public heath groups funded by govt should stop lobbying govt or have their money withdrawn.

    This dangerous practice of giving so-called charities money to then argue for more regulation is anti-democratic and shuts out the voice of the many. If health groups ideas on regulation are so popular with the masses surely they can raise a few thousand £ to do lobbying. If they cant raise the money, then their activities should rightly not be supported by the taxpayer. It really is that simple. Right?


  6. Junican Says:

    I read up about this matter a few days ago. It seems that it was ASH which proposed this nonsense to a Treasury committee a few years ago.
    What they intend to do with the info is this:

    1. Collect together the data supplied by GPs and total all interviews.
    2. Estimate the number of interviewees who will agree to try smoking cessation.
    3. Estimate the number who will quit for four weeks.

    (NB. ASH said that they do not want 12 month follow-up since it would be ‘counter productive’)

    And what would the purpose of all this accounting be? Could it be that it will provide evidence of the great success of smoking cessation provisions?


  7. Gasper Says:

    Have you seen this today from the Royal College of Physicians and the Royal College of Psychiatrists? http://www.rcplondon.ac.uk/press-releases/smoking-neglected-people-mental-health-conditions-leading-premature-death

    They claim that “One in three of the UK’s 10 million current smokers has a mental disorder.” (an epidemic of sorts surely?)

    One of the key recommendations is sure enough that “service indicators, such as the primary care Quality Outcome Framework (QOF) and Commissioning for Quality and Innovation (CQUIN), should measure and INCENTIVISE cessation, not just delivery of advice to quit.”

    They also say this “Over the course of a year, only half of smokers with mental disorders are advised to quit and only one in ten receive prescriptions of medicines such as Nicotine Replacement Therapy (NRT), bupropion or varenicline* that can help them to quit.”

    The reason that varenicline is asterisked is because this is the brand Chantix. Chantix has been linked to depression, suicidal thoughts, suicide attempts and completed suicides in patients taking Chantix. 2,700 federal lawsuits have been filed against Pfizer Inc.’s smoking cessation drug Chantix – which expects to pay out $270million in settlements. Sound like a good thing to prescribe people with mental disorders?


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