TY - JOUR T1 - The QOF, NICE, and depression: a clumsy mechanism that undermines clinical judgment JF - British Journal of General Practice JO - Br J Gen Pract SP - 432 LP - 433 DO - 10.3399/bjgp11X582994 VL - 61 IS - 588 AU - Les Toop Y1 - 2011/07/01 UR - http://bjgp.org/content/61/588/432.abstract N2 - The National Institute for Health and Clinical Excellence (NICE) has commissioned guidelines for the treatment and management of depression in adults from the National Collaborating Centre for Mental Health. The full 700-page updated edition (guideline 90)1 was published in 2010, replacing the 2004 guideline 23 which has been credited with providing the rationale behind the Quality and Outcomes Framework (QOF) depression indicators.2 Guideline 90 now eschews population or opportunistic screening, instead promoting increased awareness and case finding of depression. A step-wise approach to treatment based on semi-structured severity assessment is also recommended with an emphasis on the importance of considering functional impairment.Guideline 90 is an interesting if substantial read. It contains a collection of viewpoints which collectively provide an excellent example of how and why general practice can be an uncomfortable and confusing place. How should it respond to simultaneous accusations of over and under diagnosing depression, over and under treating, and of being both under and over structured in its approach to a ‘condition’ that, by its nature, is impossible to define clearly, and which at one end overlaps with the emotional ups and downs of normal human existence in an increasingly stressful society?How then was a controversial part of a NICE guideline allowed to become enshrined into one-size-fits-all indicators for the uncontrolled pay-for-performance experiment that is the QOF 3The evidence to support a population or opportunistic screening approach for recognising depression in general practice probably never existed. It has been … ER -