At a meeting recently a senior gastroenterologist asked me archly, ‘Can I be cynical and say GPs don’t prioritise gastroenterology because it is not included in the QOF?’
Actually that is not being cynical (but displays a naivety about how incentives work). While we can try to hold out against tick box medicine, it comes at a price to our practice incomes – and therefore those of our staff as well as ourselves.
The QOF has been a remarkably effective tool for changing GP behaviour. These changes have occurred within the consulting room and beyond. They may have resulted in better recording and sometimes in outcomes, but at a cost.
The cost has been to the doctor-patient relationship where the suspicion can always be that the patient’s agenda is hijacked and their needs are subsidiary to filling some template for the doctor’s gain. And a doctor looking at a computer is not connecting with the person who has come to see them.
A further price is to be paid by the diversion of time, training, attention and education away from those areas not in the QOF. Gastroenterology is one of these areas, though granted it can be slightly affected through prescribing and cancer domains. Not being included in the QOF has not been neutral for us; it has been positively harmful.
How then can we influence GP behaviour? In particular, the PCSG would like to see more GI cancers diagnosed earlier and have a campaign, Think GI Cancer, to achieve this.
Wags will wheel out the (now clichéd) phrase that getting GPs to do something is like herding cats. Clearly they know nothing about cats. My cat will never be pushed or bullied anywhere, but put some food down and he will be there in a flash. Perhaps we should think about attractors for GPs?
Our campaign, Think GI Cancer, which aims to diagnose GI cancer earlier has no funding to change clinical behaviour. And general practice is on its knees and would not welcome something that looked like an additional task.
What we need to do then is offer some form of respect and professional satisfaction in this area. The attractor would rely on soft power not hard cash.
I am convinced we can devise something that that improves GI cancer outcomes and restores pride to one small part of general practice. I’m not sure just what this programme looks like yet but we will make GI cancers a little higher on the differential list, GPs better aware of the significance of certain symptoms and signs, and confident in ordering investigations. Earlier if appropriate.
What the next actions to get to this point are will evolve as we gain traction but they will be clear, achievable and reported on this site in the near future.