The Quality and Outcomes Framework: Body commodification in UK general practice

Norman, Armando Henrique; Russell, Andrew J.; Merli, Claudia

doi:10.1016/j.socscimed.2016.10.009

Cited by 16 publications

(23 citation statements)

References 41 publications

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“…For instance, clinicians often tend to speak to their patients in terms of 'Mr "X" your chances are…', but forget that EBM operates at very abstract mathematical realm of population-based study trials which know nothing about Mr "X", making it quite impossible in the case of preventive measure to transfer results to that person in particular. Thus, over time clinicians have undergone an acculturation process through training programmes, whereby this predictive reasoning has become normalised as best practice backed by, and incentivised to conform to pay-for-performance schemes, within which QOF stands as an example (Malhotra et al, 2015;Russell;Merli, 2016).…”

Section: High-risk Strategy: Advantage For the Pharmaceutical Industrymentioning

confidence: 99%

“…The aim has been to improve the quality of clinical care in general practice by setting an evidence-based clinical governance framework. The QOF 2013/2014 contract year offered 900 points and was organised into four domains: Clinical, Public Health, Quality and Productivity, and Patient Experience Russell;Merli, 2016).…”

Section: Prevention Becomes Medicalizedmentioning

confidence: 99%

“…This again creates a market reserve to be exploited by the biotechno-industrial complex operating upon a landscape made up of the collective human body. The strategy of this industrial complex may involve increasing patients' awareness about disease-related risks and specific preventive measures to be consumed, as well as by improving doctor-patient effective 'therapeutic' alliances through powerful discourses of EBM (Lambert, 2006) distilled into a set of financially incentivized scientific-bureaucratic rules (Harrison;Moran;Wood, 2002) embedded in pay-for-performance schemes to which clinicians have to conform Russell;Merli, 2016).…”

Section: Success Is Only Palliative and Temporarymentioning

confidence: 99%

“…Thus, EBM can also be recognized as 'an indeterminate and malleable range of techniques and practices united not by particular kinds of methodological rigour, but by the pursuit of a new approach to medical knowledge and authority' (Lambert, 2006(Lambert, , p. 2639. In the UK context, this approach has led to the development of a robust clinical governance structure that paved the way for implementing the largest payfor-performance scheme in the world: the Quality and Outcomes Framework (QOF) Russell;Merli, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…In section four, we contend that the trends in prevention have centred on the misapplication of HRS by gradually reducing cut-off points for preventive interventions as means for addressing major disease outcomes. Based on two examples from an ethnographic study Russell;Merli, 2016) of the QOF scheme, our final section highlights the advantage of prioritising HRS over PS to pharmaceutical industries. We argue that HRS has become mainstream in prevention because it fits a neoliberal economic approach to viewing health as a commodity.…”

Section: Introductionmentioning

confidence: 99%

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Linking high-risk preventive strategy to biomedical-industry market: implications for public health

2017

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This paper takes Geoffrey Rose's concepts on preventive strategy as the basis for theoretical framework to critically analyse the current approach to disease prevention. Rose's "continuum of risk and severity" has widened the scope for preventive actions and underpins two approaches: high-risk strategy (HRS) and population strategy (PS). Both of them produce paradoxes: HRS, despite having a good harm-benefit ratio, offers little impact on public health; PS has greater impact on public health, but offers minimal benefit at individual level. We argue that HRS is being misapplied by reducing cut-off points for preventive interventions to impact morbimortality attributed to specific diseases. This tends to medicalize prevention, producing more disease related phenomena through screening techniques, and inducing individual affective reactions, which require action in the present to secure better future health. This context has paved the way for speculative preventive medicine, which perceives health as a commodity but ignores its implications for public health services.

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Section: High-risk Strategy: Advantage For the Pharmaceutical Industrymentioning

confidence: 99%

Section: Prevention Becomes Medicalizedmentioning

confidence: 99%

Section: Success Is Only Palliative and Temporarymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Linking high-risk preventive strategy to biomedical-industry market: implications for public health

2017

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Negotiating Social Protection and Care: A Study of First-Generation Older Turkish Community in London

Yazdanpanahi

2023

Ageing Int

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Access to social protection in old age is crucial and yet contingent upon negotiations between the social structures of the welfare states and the personal networks within which individuals are embedded. International migration, changing family dynamics, and the transformation of care and other welfare policies in the global North make it challenging for older migrants to negotiate social protection. Drawing on 45 semi-structured interviews with first-generation older Turkish migrants in London and 13 semi-structured interviews with professional service providers for the community, the paper aims to investigate the assemblages of formal and informal social protection in the lives of older migrants. Findings indicate the complexity in accessing informal social protection and the navigation of formal care support in the UK for first generation older Turkish migrants and the contingency of access to formal care services on informal support networks for participants. It has been demonstrated that built infrastructure and policies aimed at older adults have great influence on assemblages of care, highlighting the need for more age-friendly and integrated policies to facilitate access to social protection for diverse groups of older adults.

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The emergence of multimorbidity as a matter of concern: a critical review

2022

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Multimorbidity is considered one of the greatest emerging challenges for contemporary health care systems. However, the meaning of the term ‘multimorbidity’ is not straightforward. Despite many attempts to clarify the definition and its measurement, the concept remains elusive. Still, academic interest in the study of multimorbidity has grown exponentially in the past ten years. In this paper, we trace the emergence of multimorbidity as a ‘matter of concern’ within health care research, exploring what has been called ‘the multimorbidity epidemic’ in the context of changing disease categories. We analyse how multimorbidity as a concept lays bare some major unresolved challenges within contemporary care services and summons up traditional primary care ideals of holistic, person-centred care. However, we argue that the current focus on the measurement and the identification of disease clusters falls short in contributing to better care for people who live with multiple long-term conditions now. Instead, we propose a novel understanding of ‘multimorbidity’ as an experience that manifests through people’s navigations of care infrastructures. To study this experience of multimorbidity, we discuss the potential of social science approaches that focus on ‘living well’ with illness.

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The Quality and Outcomes Framework: Body commodification in UK general practice

Cited by 16 publications

References 41 publications

Linking high-risk preventive strategy to biomedical-industry market: implications for public health

Linking high-risk preventive strategy to biomedical-industry market: implications for public health

Negotiating Social Protection and Care: A Study of First-Generation Older Turkish Community in London

The emergence of multimorbidity as a matter of concern: a critical review

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