Tony Kendrick1 has produced some evidence that shows that the use of the Hospital Anxiety and Depression Scale can lead to more selective prescribing of antidepressants. This does not surprise me at all, and if he reads my column2 again, he will find that nowhere do I suggest that the use of scales ‘will encourage antidepressant prescribing’. My concerns are more profound than the simple issue of the level of prescribing, and I think they are worth re-iterating, especially since Tony was involved in developing the Quality and Outcomes Framework (QOF) mental health indicators and has not responded to the deeper thrust of my opinion piece.
Put briefly, I have two points to make, one specific to the management of depression, the other more general. Specifically, I fear that the routine use of depression scoring scales will detract from the human interaction between doctor and patient that is so vital to the consultation, especially when approaching emotional and psychological issues. To provide evidence for and against this proposition would require a far wider remit than the one used in Professor Kendrick's study, and might be almost impossible. Unless and until such evidence is available, I strongly believe that individual GPs should be allowed to follow their own approach to management, which may or may not include the (selective) use of quantitative screening instruments.
The more general point relates to the insidious and apparently unstoppable trend towards centrally dictated micromanagement of primary care by government, aided and abetted by expert advisory groups and mediated through the QOF. The Back Pages carry pieces lamenting this trend in every issue (see Mark Vorster's letter and Mike Fitzpatrick's column in the October issue for examples), as does every other current UK medical journal and newspaper. Practice common rooms echo the same tune, and I don't know of a single GP colleague who does not regret at least a part of this takeover of our professional independence.
What can we do about it? I suggest that at the very least we can fight back — at some cost to our own pockets — by declining to comply with those parts of the QOF that offend us the most.
- © British Journal of General Practice, 2006.
