ABSTRACT
What most GPs know about pathologists could be written in large capitals on their thumbnails. That is unless they happen to marry one, which is unlikely, as they never meet them. What most GPs know about modern pathology could probably be written in slightly smaller capitals. There are several reasons for this less than ideal state of affairs. Older GPs' memory of ancient lectures and unreadable textbooks has decayed with the passage of the years, and although they have been on many refresher courses, pathology per se has never been a strong draw: 'Let's go to the lecture on cardiology or diabetes - there will be passing mention of some of the latest clever tests, but more importantly this will tell us how to get the points for the NSFs and our new contract.' Everyone knows what points mean. They mean prizes or, more accurately, 'quality' money in the chronic disease management allowances. So to take diabetes and the laboratory as an example using the current version of the 'new' contract, a total of 99 points are up for grabs. Of those relating to the laboratory, 3 points are available for having a record of HbA]c in the previous 15 months, and 11 points are available for practices that can achieve an HbAlc of 10 or less in at least 85% of patients on their diabetic register in the last 15 months. There is a sliding scale of points from 85% to a threshold of 25%. If your brain is beginning to hurt, you are not alone, and this is but a tiny fraction of the Byzantine system that is being introduced. But let us press on. There are 16 points available if 50% of diabetics have an HbAlc of 7.4 or less. Some committee in its wisdom, perhaps even with real live pathologists sitting on it, has decided that 7.4 is the magic figure, although there is a slightly worrying proviso that says 'or equivalent test/reference range depending on local laboratory.' This seems to provide a real opportunity for GPs and pathologists to get together to provide a perhaps more realistic target locally. Flattery and naked bribery seem to be the best tactics. If 90% of diabetic patients have had their
serum creatinine levels measured in the last 15 months, that is another 3 points, and the same points apply to a measure of total cholesterol. Six points are available if 60% of diabetic patients have a serum cholesterol level of less than 5 mmol/1. It is worth noting that a detailed lipid profile, although much more useful, attracts no more points, so if you are just in it for the money such requests might decrease, which may even be a relief to an overworked laboratory. I, like many others, am unsure of the exact sums of money attached to these points, but for a superhuman practice (or one with a clever creative accounting system) the maximum number of points relating to the laboratory for diabetes would be 42, and a figure of £3,500 per average practice would not be too far away. Now in this brave new world of quality points, 70 points are available for distributing a patient survey, reflecting on it, chatting to the primary care trust and demonstrating a little bit of change. This will pull in £5,250 in the first year and £8,400 subsequently, and there are organisations which charge a fee of £60 that will do most of this for you. I write books on doctor-patient communication and am in favour of patient involvement, but it does seem that the points distribution could be construed as a little skewed.
