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GP deal 'not good for patients' GP deal 'not good for patients'
(about 9 hours later)
The targets GPs have been hitting to earn massive pay rises are not good for patient care, experts say.The targets GPs have been hitting to earn massive pay rises are not good for patient care, experts say.
Family doctor pay has now hit £110,000 on average - a £30,000 rise in the first two years of the new contract.Family doctor pay has now hit £110,000 on average - a £30,000 rise in the first two years of the new contract.
The deal rewards GPs with a bonus for hitting certain targets, such as blood pressure testing and asthma care.The deal rewards GPs with a bonus for hitting certain targets, such as blood pressure testing and asthma care.
But doctors and academics say it pushes GPs to focus on point scoring instead of individually tailoring care, the British Medical Journal reports.But doctors and academics say it pushes GPs to focus on point scoring instead of individually tailoring care, the British Medical Journal reports.
Under the deal, which started in 2004, a third of GP income is linked to hitting targets under the quality and outcomes framework (QOF).Under the deal, which started in 2004, a third of GP income is linked to hitting targets under the quality and outcomes framework (QOF).
I think the contract has been good for patient care Richard Vautrey, of the British Medical AssociationI think the contract has been good for patient care Richard Vautrey, of the British Medical Association
Most of the rest of their pay is made up of the "global sum", which is effectively a basic salary.Most of the rest of their pay is made up of the "global sum", which is effectively a basic salary.
GPs have been particularly successful in hitting the targets with well over 90% met, on average.GPs have been particularly successful in hitting the targets with well over 90% met, on average.
The experts, led by Dr Iona Heath, a GP at London's Caversham Group Practice, said the targets had diminished "the responsibility of doctors to think".The experts, led by Dr Iona Heath, a GP at London's Caversham Group Practice, said the targets had diminished "the responsibility of doctors to think".
Instead, they said, GPs were encouraged to focus on "points scored, thresholds met and income generated" - potentially to the detriment of patients.Instead, they said, GPs were encouraged to focus on "points scored, thresholds met and income generated" - potentially to the detriment of patients.
CompromisedCompromised
They said three quarters of the population do not have the diseases covered by the contract and it was too focused on treatments rather than outcomes.They said three quarters of the population do not have the diseases covered by the contract and it was too focused on treatments rather than outcomes.
"Until the increase in process is translated into tangible outcomes, such as diabetes complication rates or incidence of heart attack or smoking-related deaths, the benefits and cost-effectiveness of the exercise cannot be established.""Until the increase in process is translated into tangible outcomes, such as diabetes complication rates or incidence of heart attack or smoking-related deaths, the benefits and cost-effectiveness of the exercise cannot be established."
They also said one of the key aims of the contract - to reduce health inequalities - was fundamentally compromised.They also said one of the key aims of the contract - to reduce health inequalities - was fundamentally compromised.
They said the most socially-disadvantaged people could be listed as exceptions from the targets and "once given that status are at risk of receiving proportionally less attention".They said the most socially-disadvantaged people could be listed as exceptions from the targets and "once given that status are at risk of receiving proportionally less attention".
And the authors also pointed out that the contract acted as a disincentive to work in the most deprived areas as people tended to be sicker and therefore it was harder to hit the targets.And the authors also pointed out that the contract acted as a disincentive to work in the most deprived areas as people tended to be sicker and therefore it was harder to hit the targets.
Dr Richard Vautrey, deputy chairman of the British Medical Association's GP committee, said: "The GP contract is not just about the QOF, there is the global sum and that enables doctors to treat patients on that individual basis.Dr Richard Vautrey, deputy chairman of the British Medical Association's GP committee, said: "The GP contract is not just about the QOF, there is the global sum and that enables doctors to treat patients on that individual basis.
"And there is no evidence that the exception reporting has been abused. I think the contract has been good for patient care.""And there is no evidence that the exception reporting has been abused. I think the contract has been good for patient care."
Alastair Henderson, deputy director of NHS Employers, which represents trusts, said: "This criticism is entirely unfounded.
"There is no evidence to show that the QOF has resulted in lower levels of care for any groups of patients, in fact entirely the opposite."