To wonder if my GP has some sort of scam going?! "Smoking cessation advice" for a non-smoker

[LizB62A]

I've never smoked - this is relevant.

I've just picked up a referral letter from my GP for an ENT consultation and they've attached a brief summary of my GP appointment history (not a lot of detail but enough)

Over the last 17 years, there are 7 separate entries which state "Smoking cessation advice"

I've never been given advice to stop smoking as I don't smoke

I'm wondering if there is there some sort of NHS bonus paid to GPs who encourage their patients to stop smoking?

Does anyone know ?!

I think there is, or was at some point a cquinn attached to capturing smoking status, so it might be that where they’ve documented that they’ve asked you about smoking, on coding it comes up as “smoking cessation advice”.

I don’t work in that part of primary care so can’t go into any more detail.

Every diabetes check I get asked about smoking, given advice on drinking (I'm almost T total) and get offered statins even though my cholesterol is normal and even the GP said far too many people take them.

It's just a box ticking thing, but phone and ask reception if they have you down as a smoker.

There is CQUIN for delivery of smoking cessation advice linked to an incentive payment so it is possible they have inflated their figures.

It's all to do with Qof points like pp said

@LizB62A

They could have just got muddled up. I was having my weight monitored, and was (for example) 12 stone 5 pounds, on 3rd May 2018.

Then I went to get weighed 2 weeks later on 17th May, and was 12 stone 2 pounds.

For some reason, the nurse who weighed me, logged it as 11 stone 2 pounds!

I didn't realise this til 7th June (3 weeks later.) I went to get weighed, and the nurse said 'hmmm, you have gained weight in the last 3 weeks.' I said 'eh?! But I have been so careful and good!' She said, 'maybe, but you have still gained over half a stone. You are 11 stone 10 pounds!'

I said 'but I was 12 stone 2 pounds three weeks back, so I have actually LOST 6 pounds.' She said 'no, you were 11 stone 2 pounds 3 weeks ago, so you have gained 8 pounds.'

After a bit of debating, and pointing out that I could not have gone from 12 stone 5 pounds, to 11 stone 2 pounds in 2 weeks (3rd to 17th of May,) she finally accepted that 12 stone 2 pounds was recorded incorrectly as 11 stone 2 pounds 3 weeks earlier!!! And she corrected the record!)

So yep, it is not impossible for them to record stuff incorrectly.

A scam though? I doubt it...

My FIL was a Type 2 diabetic but reversed the diagnosis several years ago through a strict diet and exercise regime. He is still within normal ranges for everything but the practice refuses to take him off the register because they get extra funding for each diabetic patient under their care. I think it’s disgraceful.

Diabetes can't be officially cured, just goes into remission.

I don't see the harm in having all of the yearly blood tests to check his sugar levels are still in normal range etc.

My vote is for an accidental mis-coding of smoking status. No QOF money if you're coded as a non-smoker to start with!

Not completely sure. I think some of the older computer systems used to record this as a 'code' whenever someone's smoking status was added. So it would list as 'smoking advice - non smoker'. Kind of like a record the question was asked but using slightly strange language.
There are hundreds if not thousands of codes in gp systems, many of which are really clunky. My personal favourite is 'regular visits from postman' or something like that.

@Calixtine you can’t reverse a diabetes diagnosis - you might be well controlled but you’re still diabetic. Of course he should stay on the register for monitoring. It would be entirely negligent to say ok you’ve got good control bye bye. He is still at risk of complications of diabetes.

Oh and the extra funding helps pay for his care, so retinal screening, annual reviews, blood tests and foot care etc. People don’t seem to realise that “profit” in primary care isn’t like profit in a private company.

A scam though? I doubt it...

You mean like they continue claiming for patients who have died or moved away?

Over the last 17 years...

No medical records go back 17 years. Period. If a GP practice tells you otherwise its bollocks.

Tell them to remove it, its rubbish.

you can’t reverse a diabetes diagnosis

You can if the original diagnosis was mistaken. I was diagnosed after a simple blood and urine test - was prescribed metformin and GP sent off the free prescription claim. At the same time, they referred me for a glucose tolerance test, which was done several weeks later and came back non-diabetic, so they had to reverse/cancel their diagnosis. So, yes, the original diagnosis may not have been right.

No medical records go back 17 years. Period. If a GP practice tells you otherwise its bollocks.

Really? How come my GP mentioned a cosmetic operation I had when I was about 6, 40 years ago last time I was there?

My medical records show my vaccinations when I was 3 months old. I'm almost 50 now, so I'm sure records do go back 17 years or more.

Was that in pregnancy @KazzyHoward?

You can’t (or shouldn’t) diagnose diabetes with a GTT.

And of course medical records go back 17 years or more. 🙄 they go back to your birth. They might be electronic but prior to that they were paper records. They might have been archived after coding but they still exist. I’ve been using electronic records since about 2002, before that we wrote in paper notes. Electronic records exist since whenever your practice started using them.

And you can’t just “get things removed”. Post-Shipman, records are subject to audit and examination and removing things is strongly monitored or disallowed. They can be amended and marked in error, and of course you can ask for this to be done where records are inaccurate.

Ah, OK, fair enough

Still sounds like there are some dodgy dealings going on here though!

Yes they get payments for smoking cessation advice for smokers. Someone has recorded you're a smoker and they tick a box to say advice given or offered.

No medical records go back 17 years. Period. If a GP practice tells you otherwise its bollocks
Rubbish, GP records have to be retained for the life of the patient. Hospital records (for adults) can be culled after 8 years though.

It'll be a clerical error. Codes are very similar so it may be that you've had an inexperienced member of staff adding codes in yearly. And yes extra payments are made for certain illness so they get extra care it's not a scam.

Does this get attached to every referral?

Am I going to have to sit in there in front of the cardiologist knowing he knows all about my recurrent thrush / sexual health / menstrual problems or my non existent mental health problems that my GP is so keen to label me with.

Many (most) GP records are unreliable due to NHS information systems being procured via many different private / PFI initiatives over the years. All of which have failed. Sure your measles vac might be correct, but a lot of it may not be. You may have a thing or two in your records that is complete nonsense. You could have mental health counselling or cancer treatment recorded in 1988 just because of the way info systems were merged by different companies. The US company behind Yellow Pages were responsible for several NHS regions' info systems in the 1990s! Ask your GP to delete the rubbish.

No medical records go back 17 years. Period. If a GP practice tells you otherwise its bollocks

Total rubbish. Summarising paper notes into electronic systems used to be a very lucrative summer job for medical students in the late 1990s (so electronic systems certainly existed then). And I have plenty of patients with blood work on the hospital system dating back to the 1990s, and letters in the paper notes dating from the 1980s.

Sounds like they've been putting this in to get their QOF points up. Which they will receive payments for. Very cheeky!

My records had me as asthmatic, I kept asking for it to be removed. I gave up and went to my "asthma review"
Did peak flow
Nurse "you're not asthmatic"
Me "I KNOW"

It got removed