Sunday, May 31, 2009

NHS Doctors have cashed in on new bonus scheme but it 'has not helped patient care'

A lucrative bonus scheme for GPs has done nothing to improve patient care, a study claims. Performance-related pay could even be detrimental to the NHS, with GPs chasing targets 'at the cost of the quality of care given to patients'. The bonus scheme was included as part of GPs' 2004 contract, which has seen pay rocket by 55 per cent to almost £108,000.

Ministers introduced the scheme, which accounts for a third of doctors' salaries, with the aim of driving up the quality of care. But a study in the British Medical Journal indicates that in some cases it has made no difference whatsoever - despite costing taxpayers millions.

Researchers at Birmingham University compared the level of diabetes care at 147 surgeries covering one million patients across the country. They found that while there were significant improvements every year in the three years up to the start of the bonus scheme, these improvements then stagnated after it began. It is suggested this could be because GPs stop trying for further improvements once they have achieved the maximum amount of money allocated to diabetes patients.

Under the scheme, known as the Quality and Outcomes Framework, points are awarded for the management of diabetes, including targets for controlling blood pressure, cholesterol and blood glucose levels. There are 1,000 points available annually for each practice, covering a wide range of different illness achievement targets. Each point is worth up to £124 and is then shared between GPs in that practice.

But experts say it is too easy for GPs to gain the maximum number of points and suggest targets need to be more challenging if patients are to see better care. Last year 96.8 per cent of doctors gained the maximum number of points and more than 600 practices achieved 100 per cent.

Dr Melanie Calvert, lecturer at Birmingham University's college of medicine and dentistry, said: 'Our work and that of others highlights the potential unintended consequences of the scheme and raises concerns that it may not have been as efficient in reducing inequalities in health in diabetes as was hoped. 'Although the management of patients with diabetes has improved since the 1990s, the impact of the pay-for-performance initiative on care is not straightforward.' She went on: 'If anything, improvements in care appear to have plateaued since the introduction. 'This may reflect increasing difficulties in target attainments in poorly- controlled patients, but could also suggest that targets for practices need to be more challenging if patients are to benefit.'

Last year a study by the Civitas think-tank found some GPs were putting more effort into treating conditions, including asthma and high blood pressure, that attract points while neglecting dementia and osteoporosis, which do not. Dr Calvert said: 'There is a risk that doctors are focusing on patients they can achieve incentives with and are not focusing on things like osteoporosis which isn't captured in the QOF. 'There is a risk GPs are focusing on tick boxes to meet targets but not focusing on other aspects of care.'

A Department of Health spokesman said: 'Independent research has shown that care for people with diabetes improved more rapidly after the introduction of the QOF. 'We want to see continuous improvements in QOF to support GPs in delivering high quality care for patients.'


Tasmania, Australia: Nasty Health Dept. bureaucrat trying to destroy a popular and hard-working family doctor

Bureaucrat George Cerchez tried to get the doctor for wrongly treating 4 patients but when that failed Cerchez suddenly came up with another 19 allegations. No patients have complained and the other doctors in the area disown all knowledge of the complaints. It's just Georgy boy at work. A fine example of government regulation at work

PAUL McGinity is an old-style country doctor, so dedicated to his 3000 patients that he is berated by colleagues for working too hard, never refusing a home visit in the early hours and taking too few holidays. After 32 years of service to the rural community around Scottsdale, a timber town in Tasmania's northeast, Dr McGinity's career has come to a humiliating halt.

He has been linked to the death of seven patients after complaints to the Medical Council of Tasmania, which has suspended the general practitioner's registration pending an investigation. However, far from being treated as a pariah, Dr McGinity has the unwavering support of his patients, including at least one whose treatment forms the basis of a key allegation.

What's more, Dr McGinity is turning the tables on what he claims are "vexatious" accusers. He claims his chief accuser -- Department of Health and Human Services primary health adviser George Cerchez -- has a potential conflict of interest. Dr McGinity and his supporters claim his only crime is to be a thorn in the side of plans for a new $1.2 million clinic for Scottsdale.

A recording of a telephone conversation obtained by The Weekend Australian reveals DHHS secretary David Roberts saying Dr Cerchez was "not acting for the department" -- casting doubt on comments made in parliament by Health Minister Lara Giddings. While most politicians would run a mile from a doctor facing such serious allegations, the state Opposition said there was such a "stench" about the case that it should be subject to an independent review.

There are complaints against Dr McGinity relating to 23 patients, but unusually none is made by them or their families. Dr McGinity has been led to believe that all but four complaints were submitted by Dr Cerchez. Dr McGinity was notified of the further 19 cases at the same time his suspension over the first four was being successfully challenged on a technicality in the Supreme Court. The suspension was later reinstated.

Dr Cerchez, with whom Dr McGinity has a history of dispute, is also on the board of local doctors' group GP North. GP North has obtained federal funding of $500,000 to build a $1.2million medical complex in Scottsdale. Dr McGinity is not interested in joining the new clinic, preferring his old style of solo operation. The other four complainants are GPs at Scottsdale's other practice, despite their insistence yesterday that they had "nothing to do with" the allegations. It is expected the four will move to the new medical centre, which -- if Dr McGinity loses his registration -- will take his 3000 patients.

The 68-year-old told The Weekend Australian he was confident he had not made "any mistakes". And while accepting the medical council's obligation to investigate the complaints, he believed there should be an inquiry into the manner in which the allegations were made. He was "very concerned that there is an ulterior motive behind this" and that Dr Cerchez had a potential conflict of interest: "There are three factors: he is on the board of GP North; GP North wants to build a clinic; I've got lots of patients -- 3000; they haven't asked me to join the clinic but they need those patients." He said he also had a long history of "disagreements" with Dr Cerchez, including a dispute over the management of a case at the Scottsdale hospital in February last year. Dr Cerchez had transferred a patient against his direction, undermining his position, he said.

In the recording of his conversation with Dr McGinity, Mr Roberts says Dr Cerchez was "absolutely ... not" acting for the department in making the allegations. This appears to be a direct contradiction of advice given by Ms Giddings to parliament that Dr Cerchez "made the complaints as the longstanding medical adviser". Yesterday, Ms Giddings deferred to Mr Roberts, who said he had never meant to suggest Dr Cerchez was not acting for the department's primary health section. Instead, he had simply meant to convey that the "central department", which had to be divorced from such operational matters, was not involved. "The department is not trying to distance itself from Dr Cerchez ... I have been strongly supportive of the actions George has taken," he said.

Questions to Dr Cerchez were answered by DHHS deputy secretary Alice Burchill, who suggested concerns about a potential conflict of interest were "without foundation". "Dr Cerchez ... does not practise in the northeast and cannot personally benefit from the development," she said. "There is no underlying professional dispute between Dr McGinity and Dr Cerchez."

The Weekend Australian has a document naming the four GPs from Scottsdale's Victoria Street surgery who raised allegations against Dr McGinity: Linda Clow, Jim Wilson, Natalie Burch and Gretchen Stone. However, when asked to comment yesterday, Dr Clow said on behalf of the practice, they had "nothing to do with" the issue. "I don't know where you got that idea from, but we've got no comment," she said. "On behalf of the whole practice, we have not and will not make any comment. We've got nothing to do with this and we want to stay out of it." She would not say whether she and the other doctors at the surgery intended to shift to the new medical centre.

GP North chief executive Phil Edmondson would not say whether the four Victoria Street doctors had indicated a willingness to join the new medical complex. Nor would he say how many patients the new centre required to be viable. When asked whether he was confident the allegations against Dr McGinity were not related to plans for the new centre, he said: "I have no knowledge of the nature of the complaints against Dr McGinity. From the perspective of GP North, there is absolutely and categorically no link whatsoever between the matters."

The medical council, negotiating with Dr McGinity on conditions under which he might be allowed to return to practise while the allegations are investigated, could not be contacted yesterday. However, it has previously insisted its handling of the case has been appropriate.

Opposition health spokesman Brett Whiteley said Ms Giddings should address the "possible conflicts of interest" and order an independent review. "They came up with 19 new allegations -- they didn't say they came from one bloke, and they said 'they include seven people who died'," he said. "How alarmist is that? Who are these dead people? When did the first person die? Were there inquests? And if there were, why didn't the coroner report them? This whole decision needs a new set of eyes cast over it."


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