Essex GP Struck Off For Bulk Diagnosing Patients.

[Sparklingsunshine]

This is an interesting and scary story. Anyone who has read my posts regularly knows I often mention that certain conditions attract extra funding points for GP surgeries. And points make prizes, aka as cash for the practice. GP's are private businesses now and are contracted by the NHS to provide healthcare services.

Certain conditions attract a lot of points, others like hypothyroid, barely any. Depression, cholesterol, diabetes, blood pressure are big hitters. Its all part of the Quality of Outcomes Framework ( QoF). So the more patients are flagged up having these conditions the more money the NHS pays out to the practice, kerching 💰

Anyway it seems this GP's greed got the better of him and karma has finally caught up bbc.co.uk/news/articles/c15....

I find this very concerning and surely this funding model is ripe for exploitation by less than honest healthcare workers looking to make easy money. Plus it makes you wonder if this is an isolated case or indicative of a wider problem.

Anyone who has ever read their medical records knows they are littered with inaccuracies and sometimes downright bizarre entries.

[RedApple]

This appalling 'serious misconduct' apparently took place between between 2010 and 2012, which is now over a decade ago. It would be so reassuring to hear that such things can no longer happen, but...

[humanbean in reply to RedApple]

I suspect that computers and computer programs have just made it easier.

[Emaych61 in reply to humanbean]

Actually I suspect that computers make it easier to spot. Someone pointed out this happened between 2010-2012. Notes became fully computerised in 2011 (so I was told recently when asking about blood test results prior to 2011) and it was picked up in 2012. I can remember the small card envelopes that contained small pages of doctors’ notes - pages and pages of them in my case because my medical history has been complex since I was born, fifty years before records were computerised - and in various different hands.

[Sparklingsunshine in reply to RedApple]

Which also begs the question why has it taken so long for him to be struck off and how was he allowed to practice for over a decade afterwards, where are the checks and balances?

[Fruitandnutcase]

What is also worrying is - are all the patients he has ‘diagnosed’ still taking the medicines he prescribed unnecessarily all those years ago? Or was it just put it on their notes that they had those conditions?

[TiggerMe Ambassador in reply to Fruitandnutcase]

Just added to their notes thankfully, he didn't even see them

[Fruitandnutcase in reply to TiggerMe]

Phew, that’s a relief. I suppose he didn’t want the practise drug bill going up to make a dent in his profit - you would wonder that no one noticed that those patients weren’t using their prescribed meds. 🤔

[TiggerMe Ambassador in reply to Fruitandnutcase]

It sounds like dodgy bookkeeping where you claim lots of patients qualify you for a back hander.... I thought they also got paid per prescription hence wanting us on 28 day repeats rather than giving us more?... I don't know it's all a bit ridiculous and taken years to catch him 😕

[Sparklingsunshine in reply to TiggerMe]

I find the whole QOF very odd tbh, how and why do they allocate certain conditions the points they get? I know for example that pernicious anemia is very low scoring, is that because GP's are very reluctant to diagnose and treat low B12 or is it the fact its so low scoring they figure its not worthwhile diagnosing and treating it.

Some of the conditions that score highly I can understand, obviously diabetes can be devastating if left untreated, high BP can lead to strokes, heart attacks etc. I'm guessing a lot of high scoring conditions are about prevention of serious complications. Which will of course cost the NHS down the line.

The one that troubles me is them getting points for antidepressants. Now in their proper place they can be life saving and if I'm being charitable then I hope this is the motivation behind it.

However my skeptical nature makes me wonder if the huge rise in the number of prescriptions in the UK is really because our collective MH has worsened so much or is it because of the financial benefits to GP's?

Additionally people get prescribed Antidepressants for other condtions besides MH, chronic pain, migraine, restless leg, neuropathy to name but a few. Do practices still get paid for the AD's prescribed for these sorts of conditions. I'd be curious to know.

[TiggerMe Ambassador in reply to Sparklingsunshine]

🤷‍♀️

[ThyroidThora in reply to Sparklingsunshine]

Hi, the scoring of the drugs depends on the cost to the NHS. Drugs for hypothyroidism costs pennies in comparison to anti-psychotic drugs and the surgery gets more money for prescribing them. Whereas, treating cancer gets a GP surgery 1 point because it is then referred to secondary care at hospital. Lots of medical conditions don’t get treated because there isn’t any money in it for the GP surgery.

[Cornwaller in reply to Sparklingsunshine]

A student of, well anything, will understand the concept of bias and how powerful it is in determining outcomes. Much of science and most social science is non repeatable because of uncontrolled bias, ie it is rubbish. So why introduce financial bias into diagnosis? It is simply bound to skew the results. The desired outcome of health care is accurate and timely diagnosis followed by effective treatment. Why bias the process of diagnosis to produce any given outcome?

Why do doctors demean their profession by participating in such a scheme?

[Pasionaria in reply to Sparklingsunshine]

Prescribing antidepressants is not incentivised by QOF, it is a myth that GPs profit from prescribing them. You could critisise that some of them find it easier to prescribe them than to find and fix the cause of the symptoms, but it is not a financial incentive that is behind it.

[tattybogle in reply to Pasionaria]

Diagnosing /promptly reviewing depression cases is incentivised by QOF .... thus prescribing AD's is at least implicated in GP surgeries getting financial benefit .. because as we have all experienced , a GP's suggestion of depression as the cause for symptoms will invariably be followed with an offer of trying AD's ) :

cks.nice.org.uk/topics/depr... QOF indicators

Last revised in June 2024

Table 1. Indicators related to depression in the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract.

Indicator................................................................................................. Points.........Payment stages

Depression

DEP003 The percentage of patients aged 18 or over .......10 ................45-80%

with a new diagnosis of depression in the preceding

1 April to 31 March, who have been reviewed not

earlier than 10 days after and not later than 56 days

after the date of diagnosis.

Data from: [NHS England, 2022]"

[Pasionaria in reply to tattybogle]

I know for a fact that many GPs were nervous to add patients to the depression register because of the tight timeline to review them, they used to code 'low mood' rather than 'depressive disorder' to avoid putting them on the register. GPs are supposed to follow NICE guidelines for treatment and these include many other options, not just antidepressants, and advocates patient choice. nice.org.uk/guidance/ng222/...

[tattybogle in reply to Pasionaria]

yes ,i noticed there are a couple of comments in that vein from GP's at the end of this :

pulsetoday.co.uk/news/clini... /gps-join-call-for-qof-to-incentivise-reduced-antidepressant-prescribing/

[Hedgeree]

I've had my eyes well and truly opened when I found this forum. Previously I've tended to bumble on through generally trusting of authority/having a rather naive approach to life.

Recently I was checking my patient record; Apparently I was prescribed omeprazole, Apixaban and Bisoprolol at some time in the past! No dates added!? I've never had any consultations regarding heart issues? Not sure if this is a genuine mistake or what? Are they using me to obtain extra funding? Or should I have actually been prescribed these drugs but was completely unaware?

Very worrying but I'm quite suspicious at the same time. I've not contacted the surgery yet.

[Regenallotment Ambassador in reply to Hedgeree]

Ooo I would want to get to the bottom of that! Be sure to update us when you find out more 🔍🕵️🕵️‍♀️🕵️‍♂️🔎

[Hedgeree in reply to Regenallotment]

Yes I do too; just not sure how to approach the subject; do I complain and ask them to remove those drugs from my medication list? Not sure how long they've been there for or even if I am supposed to be prescribed them?

[Sparklingsunshine in reply to Hedgeree]

I would contact them without delay and ask them to explain themselves.

[Hedgeree in reply to Sparklingsunshine]

I think I'll ring them on Monday and see what they say.

[Sparklingsunshine in reply to Hedgeree]

I've had some weird inaccurate stuff on my record before which I've insisted was removed. I often wonder if this is the reason why so many GP practices are so reluctant to let us have access to our records. Worried about what we'll see.

[Humphre in reply to Hedgeree]

I know that feeling when I moved house had to move surgeries too can't get medical history from birth till my 40's this was paper & stored elsewhere not accessable although I've requested🤣 never got, rest I have a printed inch thick so I've plotted a timeline re diagnosis & medication taken, up until move surgery rest on NHS app🤦stuff missing or I believe incorrectly recorded plus stuff I can't see. Thanks to this group I'm more aware now & have been able to make progress on my condition.

[Pasionaria in reply to Hedgeree]

Years back I found out that my contraceptive coild had been removed (!!!), it turned out that there was another patient with the same name as me and her consultation had been recorded in my records. It was of course promptly removed, the consultation, not the coil. No sinister motives, just plain rushing and not paying enough attention.

[Zephyrbear]

Sadly, in Wales we still don’t have access to our records online… our surgery has just undergone a whole IT upgrade and yet the only thing we can do online is request repeat prescriptions… we can’t even make appointments on the damned system that’s just cost NHS Wales millions! 🤬

[Bearo in reply to Zephyrbear]

Well, I’m in England and I haven’t got access to my records yet. And none of us in England can book an appointment online even if the app says we can.

[AtoZ24]

One reason inaccuracies occur may be because it is the secretarial staff that do the 'paperwork' these days-they aren't medically trained and probably don't even know what they are entering onto records- it's easy to make mistakes then. I have been trying for over 8 months to get an error corrected, partly because the only people you get to talk to on the phone are the reception staff, who then tell you you have to contact the surgery to make appointments via 'Klinik' -their online platform. This is very arbitrary, and may not even be seen by a medic. The only way to get a response is to write and make a complaint. You will probably then get a phone call response to put things right. That's what is happening in my case. Even after my consultant wrote asking for the error to be corrected it is still there! Join the PPG-Patient Participation Group-every practice has one, then you can have an input onto how things are implemented or not, and how the practice interacts with it's patients.

[yorkshiregirl4 in reply to AtoZ24]

I have spent nearly six months explaining that a GP wrote that I had claimed "extra" health problems at a consultation that I know I did not say- particularly as they are not true. I wrote to the Practice manager who remains reluctant to do anything and has suggested I discuss this when the original GP returns from holiday in several weeks time. How can I have any confidence in this suggestion when the inaccuracy was identified by me so many weeks ago and nobody has done anything to put it right?

[Poniesrfun]

It's not just in your NHS. In the US, many practices are guilty of "upcoming" to increase their Medicare reimbursement. I was shocked to find out I had several serious illnesses I was not aware of when I reviewed by records – thankfully I don't actually have them except in some book keeper's imagination.

Patti in AZ

[Ireness]

I recently had an appointment with a GP at a ‘long term conditions’ clinic (not my usual GP).

He has falsified my records in that he’s put entries for my BP, Jugular pulse etc yet he didn’t actually take them.

I was a bit shocked to be honest and don’t know whether to let it go or tell my GP.

[BB001 in reply to Ireness]

Definitely tell your GP

[ThyroidThora]

Hi,

I read up on this years ago and drugs that have more points attached are antidepressants hence some GP’s are quick to prescribe them. They also have to keep chronic illness registers .

TTxx.

[Lilian15]

Well that explains it all now. For people who have PA, or underactive thyroid (possibly more but I only have those two things), if they are not treated properly they remain with many symptoms, and all those symptoms treated as individual illnesses can bring in more money than one illness treated properly. Also there is more money for diagnosing depression than there is with hypothyroid (don't know about diagnosing B12d). I remember reading a newspaper article about the UK being the most depressed people in the world (or something like that), and I remember thinking they have got it wrong, the people in the UK have the most diagnosed depression.

[annnsandell]

Perhaps more amusing than anything, one of my GPs added my weight to my notes after a telephone appointment.

[Sparklingsunshine in reply to annnsandell]

Wow that was impressive, does he also diagnose broken bones with his X ray vision remotely as well😁

[humanbean]

Hypothyroidism used to get doctors a small number of QOF points, but I can't remember exactly what they had to do to get the points. I think it was more than just diagnosis.

The QOF points for hypothyroidism were removed in, I think, 2014. (But please don't quote me.)

[helvella in reply to humanbean]

At one point, before QOF, I think there was a trivial amount for each person placed on the practice's thyroid register. The intention being to help cover the actual costs of managing the register.

Computerisation has rendered that nonsensical.

[phenelope]

sadly the points for a cancer referral are so few that a GP is incentivised not to refer on patient cash cows with diabetes or asthma.

[arTistapple]

Interesting post from so many angles. Again I feel railroaded into respecting people and organisations just for who they think they are. Turns my stomach.

[AtoZ24]

computerisation of medical records is a good thing then!

[Enuffisenuf]

How come he was only struck off (which isn't permanent) when what he did was fraud.

[Mixteca]

Talking of bizarre entries, I saw "accidental poisoning" in mine. Not had the energy to correct this and other errors 😱

I think the main issue stems from privatisation. It's been a disaster wherever it's been forced through by governments. Look at the dismal reality of NHS dentists now, assuming you can find one. There was a 10 year waiting list to my nearest one (2 mins walk!) when I moved areas.