Is it time to change QOF?
Is it time to change QOF similar DES/LES contracts and stop spending effort on patient groups that have little to gain and aren’t a productive use of resource?
We know there is little hope of new money. We therefore must do more with what we have. Given everyone is working hard we need to stop doing some things. This week we have had acknowledged by the government/NHS E that a lot of follow up outpatient activity is a waste of time. I could have told you that 30 years ago when I got told off by a consultant I worked for as a registrar when I discharged all his patients and gave him the shortest new waiting list meaning clinics got busy! A neighbour who is semi-retired paediatrician has been for the last year working in a local hospital just discharging children from follow up - so it’s still happening.
However as a Primary Care physician I know over 80% of contacts happen in primary care and we need to do the same thing as we are full to capacity too. We need to find contacts we don’t need or perhaps concentrate on those that add value to the system and in passing do the best to an individual’s health.
Hence what we need are tools to help us with Impact-ability modelling.
To give an easy example:- knowing which patient has the highest risk is one thing. I can risk stratify my PCN list and rank patients by risk quite easily. One option might be to stop seeing patients for annual reviews by say month of birth (which a lot do) and see those at highest risk first - working down the list. You could argue you are seeing those that have the most need first this way. But that’s not necessarily true.
Some of these patients will be high risk because of age or stage of disease. Many may be being seen all the time and on maximal therapy.
What we really need to do is identify those who have the most to gain from an intervention.
Who isn’t on maximal therapy - who isn’t being treated to target. who has the most to gain in terms of mortality / morbidity improvement. Often these might be your more deprived patients and one potential benefit of a “prioritise gain” approach is it might help reduce inequalities.
Of course we need to understand how much each intervention benefits a person - an interesting article this week seems to suggest NICE doesn’t always get it right. and the person needs to engage. As a GP I will say a patients idea concerns and expectations need to be taken into account and these aren’t always what the text book says.
However we need more tools - keen to hear your experiences/thoughts.