"Incentive" can be viewed on different levels.
At the most basic, I see myself driven to achieve a full 
house in part due to the financial reward (matched be 
equal feel good reward of coming first)
That the £ was actually taken away before being repackaged 
into this so called reward becomes less memorable with 
time and in several years I expect many GPs will have 
forgotten that process completely and new GPs will believe 
it was extra money.

But the incentive is removed from quality of patient care, 
in part by the existence of £, and it becomes a drive to 
get the target whether by doing the work or excepting the 
patient  - and I do feel the system encourages us to force 
that exclusion by the "3 invites and out" rule, letting us 
off the hook from trying, when in reality we have an 
ethical duty to continue trying with such patients because 
they need it and we need to tell them, the duties of a 
doctor don't stop just because he isn't paid to do 
something.

So in that respect the QOF has failed to incentivise 
quality care beyond the initial provision of standards set 
across the board.

It has succeeded in standardising expectations of care 
across the country and reduced the element of chance in 
that previously it might have depended on where or with 
whom you registered.  That is expected to lead to 
standardised quality of care (differentiated from 
expectations of quality)

But like literacy hour and numeracy hour in primary 
education, there is the risk of taking it to far to the 
exclusion of individual care and innovation in care within 
general practice.  So we find we have less time to deviate 
in thought or deed, less adaptation to suit particular 
patients.  For example, where we may have previously made 
efforts to do a home visit to a non-compliant and 
non-attending diabetic, now we can excuse ourselves "I 
asked the patient, he said no, or at least he didnt 
acknowledge my question (didnt come after 3 letters) so it 
isn't my job anymore"  that is profoundly sad and has an 
inhuman aspect to it.

Changing the targets is inevitable given the government 
placed limits on each indicator to protect their bank 
balances.
It is also appropriate to ensure consideration of less 
common illnesses and to prevent focussing only on the 
majority.
But take an idea too far and it will become stale - as it 
already has for many of us.

Of course the paranoid amongst us (including me) will see 
the government has ulterior motives to control the 
profession, to prevent rebellion, to reduce our standing 
and reduce the threat we pose to their view of the future. 
 General Practice is not what it was.  The QoF is but one 
nail in what is becoming a secure coffin.


KT

On Fri, 20 Mar 2009 10:25:07 +0000
  Adrian Midgley <[log in to unmask]> wrote:
> QOF is not an incentive payment.  Is it?