The other day a link was posted to a document listing the QOF outcomes for doctors' surgeries throughout Britain. If you paste this, gpcontract.co.uk/browse... into the top bar of your browser, it will take you there. The list shows the national incidence of a particular disease and also the local incidence, plus the incidence detected at the particular GP surgery you are looking up.
This quote from a document I found issued to Devon pharmacists explains what QOF are: "Doctors receive payment through a self reported system of outcomes. Each outcome is listed below under different headings. GPs will keep a track of when an outcome has been achieved by marking the patient record with a READ code. At the end of the year the surgery will scan all its patient records and count the number of read codes in each category." As the previous blogger pointed out, docs don't get many points for detecting hypothyroidism.
I input my surgery and found the incidence of diagnosed hypo was 1.7%, which is under the national rising average of around 3.5% which in itself is probably a gross underestimate. I looked at the result for my previous surgery, which was even worse. I began looking up the data for various surgeries around London and found none of them came up to 3.5%. This figure was generally met and sometimes exceeded outside London, although there are exceptions. The surgery with the best outcome that is relatively local (2%) to me is not taking on new patients.
The following stood out in Pharmacists document: "Pharmacists can use these QOF sections to their advantage by aligning their service provision with the outcomes that will generate income for the GPs. I estimate 1/3 of the points can be influenced by pharmacy. (336 points).For example, if a pharmacist identifies an issue with a patient’s inhaler technique and undergoes a review of this with the patient; by notifying the GP with outcome, the surgery can update their QOF records for that patient:"
I daresay they don't do much aligning of service provision with GPs' hypo patients. Ironically, although the entire system is set up to ram pills down people's throats, very many of which are of questionable value, according to recent research, the pill(s) that could do much good, whether levothyroxine, NDT or T3, are denied to many diagnosed and undiagnosed hypothyroid patients.
If you type this phrase: Quality and Outcome Framework (QOF) – What does it mean? into Google it will take you to the pharmacists doc if anyone is interested. I couldn't make the link work. If you click on it, it downloads a pdf.
This makes interesting reading. Just checked my GP practice. It is a busy practice as I have moved to a busy city, built up area, can't get an appointment for 3/4 weeks. Goes purely off TSH results. Incident hypo 2.4%
Strange that I got better treatment at my old practice. Country GP covering area' up to 15 miles in all directions. GP appointment on same day request. More interested in how patient feels rather than purely blood test. Incident 4%
So sad that I have moved or just wished I had known about Thyroid Uk at that time as old GP would have been open minded. Not unusual for me to get a phone call asking me to make appointment with GP. When going in to see him was simply told that I didn't look well last time he saw me in reception (just calling to pick up meds) just want to know how I am feeling and can he help.
Must have done his training in the medical school of life and people rather than medical school of blood tests and reference ranges. Where have they all gone?
Hi chillyfeet - this looks really interesting I have found my GP surgery and the result is 2.2% - so not great either. However the one that is actually nearer to me is only 1.8% so glad I am not there. Bristol in total 2.5% x
Hi SamBonjela - I imagine that the percentage of people with hyperthyroidism is much lower than with hypothyroidism so it's probably just that the figures are too small to publish, not that it isn't important enough. I think I read somewhere that hypoT is 5 times more common than hyperT (please correct me someone if I have got that wrong)
Also once you get into the depths of these data by clicking your PCT 'See member list for this organisation' and then the little electric drill icon on the right of Thyroid 1 or other QOF indicator, you can see all your local surgeries and how they compare - it is graphed at the bottom if you scroll down:
This is one example of a small district but can be done for the whole PCT too:
Note how one very small surgery has much higher than national average and one big surgery low figures - it's also interesting comparing this with the QOF indicator for Depression at the same surgeries.
Pity it doesn't tell you which ones prescribe T3 or NDT
My surgery is at 3.4% - doesn't mean they have a clue what they are doing though sadly
• in reply to
No, it doesn't. What it does mean I suppose is that they might be a bit more clued up on the symptoms and give their patients slightly more attention. I imagine large city practices in the main don't.
Mine is 5.8 and I had changed surgeries. I must admit am being treated very well and taken seriously.
I can't seem to get the gp.contract link to work - it comes up "Page Not Found" - any suggestions please?
• in reply to
Hi Sue-F
Just tried it myself & 'Oops! This link appears to be broken' came up ... so I clicked on 'Suggestions' clicked gpcontract.co.uk & went straight to it - hope it works for you - very interesting :o)
My current one scores a 3.6, but that is probably before the only decent GP in the practice left this year. My previous one scored a 2.7.
However, there is one within my area in the nearby village that scored a 5.6 and might be worth a look over since I'm looking for a new GP. That village is so tiny tho, you'd have never expected to find that there.
Although my practice GP is very good, looking at the results overall for the surgery, it is highly revealing to see that, since 2011, the percentage diagnosed with hypothyroidism is down, whilst the percentage diagnosed with high blood pressure, obesity, heart problems and depression is well up - all symptoms I had before I diagnosed myself, changed my doctor and asked for a test !
Can't help but wonder whether the changes to the NHS are having an effect and they are making more money from the more expensive drugs being prescribed for these symptoms.
I think you are right, Polaris, both about the drugs and also that the symptoms of hypo must often be hidden in the high blood pressure, obesity, heart problems and depression symptoms. Hypo people also have diabetes as well.
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I have found my GP surgery and the result is 2.2% - so not great either. However the one that is actually nearer to me is only 1.8% so glad I am not there. Bristol in total 2.5% x
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