DoH clampdown over exception reporting 'abuses'
The Department of Health has signalled a clampdown on GPs' exception reporting rates as new data cast doubt on the way this year's diabetes targets were achieved.
The department has circulated new software called Apollo to all trusts to allow them to analyse and challenge rates of exception reporting more easily.
The crackdown has been prompted by a series of warnings from QOF experts over potential abuses of the exception reporting system.
An analysis from the National Primary Care Research and Development Centre (NPCRDC) has found 'very high' exception reporting rates at a 'substantial minority' of practices.
The study, which has yet to be published, came as a Pulse analysis of QOF data revealed surprisingly high exception reporting rates for some diabetes indicators.
Estimated rates for DM6 the percentage of patients with HbA1c 7.4 or less show 28 per cent of English practices excepted over 10 per cent of patients and 8 per cent over 20 per cent (see graph, right).
GP clinical leads warned rates of 5-10 per cent would be acceptable but anything higher would raise suspicions.
A department spokesperson said: 'We have been concerned by anecdotal reports of variability in exception reporting. We particularly expect PCTs to challenge behaviour which seems to be placing patient care below achieving a target.'
Dr Tim Doran, public health research fellow at the NPCRDC and researcher on its analysis, said: 'We have found a substantial minority of practices where levels are very high. You have to have some suspicions because it's so much higher than average. It's a very sensitive issue.'
Dr Tony Snell, medical director of Birmingham and Black Country strategic health authority, said PCTs in his area were scrutinising diabetes indicators in particular 'almost certainly' including HbA1c and micro-albuminuria.
The Pulse analysis revealed that a small number of practices had exception reporting rates of 30 per cent or higher. Dr Tony Snell said: 'You wouldn't expect levels like that. It would certainly raise suspicions.'
Dr John Guy, clinical lead at North Essex's Education Quality In Practice, said the results were worrying. 'Anything over 10 per cent would be pushing it.'
Dr John Corcoran, a GP in London and QOF assessor, raised concerns in a letter to the BMJ, warning: 'A matter of concern is the apparently inconsistent manner in which the targets were reached.'
System's loopholes may be closed
The controversy over exception reporting has reopened the debate over whether it should be dropped from the contract.
NHS managers see exception reporting as a 'get out of jail free card' that makes it too easy to hit targets but GPs have vigorously defended the system.
Dr David Jenner, NHS Alliance contract lead, said he thought exception reporting was unlikely to be scrapped completely but should undergo significant revisions.
'I think it will continue and will have to in some form, particularly for allergies and contraindication to medication.
'But there is a strong case for it to be revised, particularly around the maximum medication and unsuitable for treatment exceptions.'
Dr Tim Doran, public health research fellow at the NPCRDC, said the exception reporting system was wide open to abuse and would need to be reviewed.
'There's always the potential for gaming. There is some discussion of will it be going on when the contract is negotiated again.'