A recent article in Primary Care Diabetes examines the question of whether pay for performance has improved the management of diabetes in the United Kingdom. Over the past decade, the UK government has introduced a number of major policy initiatives to improve the quality of health care. One such initiative was the introduction of the Quality and Outcomes Framework (QOF), a pay for performance programme for general practices launched in April 2004. The QOF aimed to improve the primary care management of common chronic conditions including diabetes. The introduction of QOF has been associated with improvements in the quality indicators for diabetes care included in the framework. However, it is difficult to disentangle the impact of QOF from other quality initiatives as few studies have adjusted for underlying trends in quality. QOF may also have reduced inequalities in diabetes care between affluent and deprived areas. Less is known about the impact of QOF on aspects of diabetes care not included in the framework, including self-management and continuity of care.
Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have
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