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Independents' Day

An alternative to exception reporting

Dr Bill Beeby's article on exception reporting suggested excepting a patient whose lithium level was below the QOF threshold but who was otherwise well.

Ethical exception reporting

There is another option in this situation.

Some clinicians are unaware that if you choose to record a patient's lithium level using the Read code 44W80 (the rubric for which is ‘lithium level therapeutic') then this code ‘counts' for the QOF, irrespective of the serum level of lithium that is attached to it.

This can be very helpful when the patient is ‘failing' the QOF, but you don't feel clinically justified in increasing the lithium dose.

The advantage of this solution is that the patient still counts ‘for' you under the QOF rules, whereas Dr Beeby's exception reporting solution just stops the patient from counting ‘against' you – not quite as helpful when there are such small numbers of lithium patients in the average practice.

From Dr Simon Clay,

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