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QOF: Ask them about their smoking habits! By Nicola Davies

by in QOF

By Nicola Davies

As I write this, we are 2½ days from the end of the QOF year… it’s been a while since I had a rant and I thought I’d share this latest one with you.

Some of you will know that QOF has now been running for 15 years – so this is very definitely not new, nor is it rocket science (despite what the medics might think!). Many of the domains have remained consistent, even if the criteria has changed somewhat. One of the things has hasn’t changed is smoking status – and the fact that we should be saying “you know you ought to stop and here’s the contact details for my smoking cessation advisor…”  to every patient who admits to having a ciggie every now and again. And yet, here I am with exactly 22 ‘proper’ working hours left for this financial year, trying to desperately find the odd microscopic piece of a point for a few patients left un-coded.

So here’s the rant – if you see your GP with a cough, a chest infection, the merest hint of phlegm, why oh why can they not code whether or not the patient smokes?! Is this not appropriate? I would expect to be asked whether I smoked or not as I hacked up a small piece of my lungs in the consulting room. I would think it highly odd if they didn’t ask me. For the record I don’t and never have, but unfortunately have been blessed with a pretty poor set of lungs. I raised this with the powers-what-be, because (and here’s the rub) they do ask, and they do write it in the notes – but how many more times need I say “NOT IN BLOOMIN’ FREE TEXT YOU DON’T!…”

We’ve recently changed summarisers – and I’ve just been made aware that no-one had actually talked about coding CT scans to the newbie… you know, the really important scans that patients have when they have the misfortune to suffer a stroke… so I’ve had to go through notes (even the old Lloyd Georges in some cases) to find the dates – making sure it’s between the right time frames obviously and then have to take that back to the docs for verification… We have a really good TIA service locally where everyone who goes in, has a CT – it’s a given, a no-brainer, pardon the pun.

I did say it wasn’t rocket science didn’t I?!

My nurses are brilliant, they’re lovely. They’re patient with the patients, efficient, don’t often run late and are very accommodating. I’ve even gone to the expense of bolting on a very specific piece of software that allows data to be searched within the clinical system and warns us that ‘stuff’ is overdue.  Do they see the big red warning in capital letters on the main patient screen? Do they action said big red warning that’s written in big red capital letters? What do you think?!

And yet, when we discuss QOF in our regular monthly meetings (with both docs and nurses), when I am reminding them of our current points situation and where we ought to be focusing our energies accordingly; they all smile and say,

“oh, of course, we’re doing that…”

“yes, I’ll remember to do that for you…” 

“oh you don’t need to remind me how important that is…” WELL, obviously I do.

And so my spleen is vented, that nasty vein in my forehead is starting to pulse, and quietly under my breath, my language gets worse as I question what the actual you-know-what have they been doing. Surely that 20 minutes the nurse had with that asthmatic patient was sufficient to see the patient, sort out their inhalers, ASK THEM ABOUT THEIR SMOKING HABITS, and merrily send them on their way. It’s not like the template doesn’t point them in the right direction is it?

Of course, we can argue until we’re blue in the face about how useful QOF is, the clinical appropriateness of putting a tick in a box to say that a statin isn’t indicated or an anti-platelet is contraindicated. Whether we like it or not, we still have to do it – because quite frankly, I can’t afford not to.

Looking back at the meetings I’ve had with clinicians over the years, in the various practices where I have worked, I really ought to have had the common sense to record the damn thing and I could just play it back to them without me even being in the room. Now THAT would be a great use of my time! 

By Nicola Davies


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Nicola Davies

Nicola Davies

Practice Manager regularly ranting about the NHS. 35 years in Primary Care and still getting irritated by constant change for change sake!

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2 Responses to “QOF: Ask them about their smoking habits! By Nicola Davies”
  1. Avatar
    Dr. Andrew Challis Says:


    I think you have the right tool to start to look into this, “Why”.
    Find out from the individuals what is actually happening in the encounter and why, explore the expectations, the threats previous experiences etc. Offer something to make that encounter easier, less stressful etc. Rather than offering another stick to be beaten with.



    • Avatar
      Nicola Davies Says:

      Hi Dr Challis – to be honest, this is a little tongue-in-cheek as we approached the end of year and an opportunity for a some light relief at an otherwise stressful time.
      Thanks for reading!!
      Best wishes


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