Exception reporting crackdown amid QOF gaming claims
By Lilian Anekwe
GPs face a crackdown on exception reporting and tough scrutiny of disease registers, amid accusations that some have manipulated data to systematically game the QOF.
A Government-funded report claims to have uncovered evidence that low-scoring practices have deliberately removed patients from disease registers and others have artificially inflated their prevalence figures to maximise financial gains.
The report, which is being considered by ministers, also alleges that GPs in low-performing practices inappropriately increased their levels of exception reporting the following year to boost QOF scores.
The analysis, a follow-up to research published last year and revealed by Pulse, follows last week's controversial National Audit Office report calling for exception reporting rules to be tightened to prevent GPs from gaming.
The NAO report recommended that the Department of Health ‘reduce the level of exceptions allowed under the QOF' after finding wide variation between practices.
GPs reacted angrily to the ‘serious accusations', but NHS Employers said the NAO recommendations would be a significant contributing piece of research' which would inform future talks with the GPC.
The new year-on-year analysis of the performance of 916 practices found those scoring above the upper threshold for an indicator in 2004/5 had a reported prevalence 3.5% higher the following year.
Low-achieving practices appeared to reduce prevalence figures and had exception reporting rates of 8.6%, compared with the expected level of 7.25%. Overall 10.9% of exception reports were deemed inappropriate.
Professor Hugh Gravelle, the report's author and professor of economics at the University of York, said the 78% rise in the average price per point – from £70 in 2004/5 to £124.60 in 2005/6 – meant ‘there was a considerable increase in the financial reward for increasing the proportion of eligible patients treated'.
His report concludes: ‘The QOF makes it easier for practices to manipulate the denominator without direct harm to patients and our evidence suggests some practices did so.'
Professor Gravelle said he had submitted the report to the department, and added: ‘I imagine it is looking at exception reporting in order to decide if it wants to include it in future QOFs.'
A Department of Health spokesperson said: ‘Manipulating QOF data is unacceptable and unfair on the majority of practices that comply with QOF requirements. PCTs should analyse exception rates and prevalence, investigate outliers, correct QOF payments where necessary and take action if they uncover fraud.'
Adrian Jacobs, co-chair of the NHS Employers' QOF negotiating team, said: ‘There are pockets where exception reporting needs looking at.'
Pulse has learned that GPs in several areas of the country, including Cardiff and Birmingham, are already under investigation for artificially inflating their prevalence figures.
Dr Steve Brinksman, a GP in Birmingham, was scathing about the local approach to QOF assessments. He said: ‘It doesn't say a lot about the high-trust approach. Deliberately gaming prevalence is a serious accusation. Even if it's not an outright allegation of fraud it's sailing close to the wind.'Dr Steve Brinksman: scathing about approach to QOF assessments in Birmingham Dr Steve Brinksman: scathing about approach to QOF assessments in Birmingham QOF figures