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'Why moving targets put GPs in firing line'

A surprise Read code change has left Dr Pablo Millares Martin wondering if GPs have been hindered deliberately.

Fury drove me to write this. On 11 October I became aware that there had been an update in the software dealing with our quality points because our figures had suddenly dropped.

On looking into what had happened to our missing points, I found that there had been a change in the allowed Read codes for assessing dementia. There was now only one code - and it was not the one we had been using.

The day before on 10 October, the practice was happy that 60 per cent of our dementia patients had received the check up; now, none of them had been reviewed according to the quality framework software.

This is not because we had failed to do the work. It is simply because once more GPs are being treated like fools by a government that has changed the rules of engagement half way through the year and without forewarning us.

Questionable motives
If a Read code was allowed when the parameters were set for this year, I can see no reason to change it midway. The only motive in doing so, that I can see, is to cause practices to miss points. We are creatures of habit and having learned to perform a task in a particular way, we will usually continue to do it that way rather than think up a more efficient way to do it. If the desired end result is the same whatever the process, why bother to impose an unnecessary change on us?

When training to become doctors, we learned that medicine is an inexact science, indeed almost an art, because there are many different ways to practise it.

Our training does not required us to pass tests on how to manage software, even though some GPs have computer studies degrees.

Nor are we taught the crucial business skills we need to negotiate efficiently with the NHS.

A running battle
GPs are fighting for survival in an ongoing primary care war.

We face clinical battles every day, trying to sort out whoever comes through our consulting rooms.

We are frequently engaged in running skirmishes to protect our reputation and our contract from recurring media and government attack.

We struggle to get the best of our computers, dealing with technical problems and, depending where we practise, different clinical software.

Since 1999 I have worked with five different IT systems at my practice. We are having to change our system yet again as no clinical software is ever suitable for more than a couple of years.

Then there is the daily struggle with Read codes that force GPs to write things in a specific way to enable us to be audited by others.

Once upon a time we sometimes missed information under our noses if we could not read colleagues' handwriting. We have moved to legible text on computer, but, as if to balance that gain, we have the Read codes to contend with.

If the code you use is not the appropriate one, it does not matter what work you have actually done. If the code is wrong it does not count.

Patients, not presentation
With most of these difficulties, GP are unfairly disadvantaged. We should be focusing on patient care and not on presenting our work in a particular way. Spinning should be left to the government.

GPs have to be on the defensive. Whenever we do not keep an eye on what is going on, the rules are switched around.

The problem with this particular Read code is just one example. Getting a code wrong makes no difference to the care that our patients receive and this will continue to be the case in future. It just penalises us financially.

Dr Millares Martin is a GP in Leeds.

Obstacles to good practice
GPs are hampered by:

  •  Frequent Read code changes.
  •  Media and government attacks.
  •  Inadequate IT systems.
  •  Needing to work defensively.
  •  Unfair financial penalties.

 

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