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The GPC believes the guidance on exception reporting is clear, but GPs are telling Pulse a different story ­ Rob Finch analyses the results of our latest survey

GPs are crying out for advice over how to exception report after a Pulse survey revealed only a tiny proportion have been offered adequate guidance by their PCT.

But GPC negotiators insisted the contract guidance was clear and told GPs they should go to their LMCs for definitive answers as PCTs 'may have a different agenda'.

The GPC advice came as GPs reported vastly differing plans on tackling exception reporting after the Department of Health refused to offer national guidance to clear up the confusion.

Analysis of the first 136 responses to the Pulse survey revealed that GPs expect exception reporting to be the biggest area of contention during quality assessment: 10 per cent of those surveyed expected major problems with their PCOs, and a further 67 per cent feared at least some


Dr John Thompson, a GP in

Pengroes, Gwynedd, said his practice was heading for major conflict with the local health board over non-

attenders. 'We haven't had much guidance and we're not quite sure what measures should be taken with DNAs,' he said.

A clear majority of GPs in the survey faced a confidence crisis over whether their levels of exception reporting would prove acceptable with a quarter saying they were 'not confident at all'. And 98 per cent of those surveyed said their PCOs had not given them adequate advice on how to exception report.

Dr Rachel Ward, a GP in Stourport-on-Severn, Worcestershire ­ one of just two respondents who said they had comprehensive guidance ­ said: 'The important thing is not to overuse exception reporting.'

And Dr Richard Lawrence, who practises in West Byfleet, Surrey, said that he was 'very confident' in his exception reporting because he was only doing it in extreme circumstances for fear of punitive action.

GPC deputy chair Dr Laurence Buckman said the system was meant to be easy. 'Don't be too clever,' he urged GPs.

He added: 'Of course there will be some PCOs that will take the opportunity to have a poke at general practice but most won't have the time or the energy.'

The survey also showed GP opinion is divided on the clinical dilemmas posed by exception reporting. Most GPs are opting for quality points by vaccinating all over-16s with asthma against influenza, rather than following the CMO's advice to only vaccinate moderate to severe asthmatics.

Almost two-thirds plan to exception report ?-blocker therapy in COPD and heart failure patients.

Dilemma 1 flu vaccination for mild asthmatics

54% will vaccinate all over-16s

18% will vaccinate only over-16s with moderate to severe asthma

06% will exception report patients with mild asthma

22% remain undecided

01% have no hope of vaccinating asthma patients

Dilemma 2 exception reporting ?-blocker therapy

in patients with COPD and heart failure

61% will exception report

38% won't exception report

01% remain unsure

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