NHS health checks and QOF increase overtreatment

GPs in the UK have two options when dealing with the massive numbers of patients who present because of mildly raised blood pressure readings.1

Option 1: we can diligently check the blood pressure many times, discuss lifestyle changes, and arrange regular follow-up, when we will have to go through the whole discussion about treating or not treating with drugs again. When such a patient has a stroke we will be blamed.

Option 2: we can start the patient on drugs and treat the blood pressure according to a protocol, probably delegating the job to a nurse. If the patient has a stroke, we are not blamed. If the patient gets side effects that is the drug’s fault, not ours. We will be paid more because our “prevalence” of hypertension will be high and it will be easy to hit our Quality and Outcomes Framework (QOF) targets for blood pressure control.

Just in case we are tempted to stick to our principles and ignore the QOF bribe, there is another consideration. If we fail to hit our QOF targets, not only will we lose money but our NHS choices score will go down. The Care Quality Commission and our patients will regard us as a bit suspect and wonder what else we are bad at.

Until the QOF starts to pay attention to Cochrane reviews and other relevant evidence it will be difficult for GPs to change the practice of overtreating mild hypertension.