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Government demands tougher exception reporting rules

By Lilian Anekwe

GPs may face tough new rules on exception reporting after the Government instructed NHS Employers to begin talks with GP leaders over reform of the controversial system.

The Department of Health branded variations in exception reporting as ‘unacceptable' in its response to consultation on the QOF.

Exception reporting didn't fall within the scope of the consultation, but GPs were nevertheless attacked for ‘gaming' of the QOF by both nurses and NHS managers.

The Royal College of Nursing risked a row with GP professional groups after calling for an independent evaluation to assess ‘potential perverse incentives for gaming of exception reporting'.

The DH, in its official response, said it had been urged by a number of submissions to take action against ‘high levels of exception reporting', which have reached 30% in the case of one chronic kidney disease indicator.

‘We will continue to review the evidence on variations in exception reporting and support PCTs in working with practices to tackle unacceptable variations,' the DH said.

‘We will ask NHS Employers to discuss with the GPC whether there are ways of improving current exception reporting arrangements,' it added.

The focus is likely to fall on areas with historically high levels of exception reporting, including not only CKD but also diabetes, dementia and prescribing beta-blockers to patients with coronary heart disease.

NICE has previously said it may consider scrapping exception reporting or only allowing it if target thresholds are raised closer to 100%, while the DH has been advised by academics to reduce the number of categories for which it is allowed.

NHS Employers, which has previously issued instructions to PCTs to ‘confirm and challenge' practices suspected of gaming, refused to comment on the latest push to reform the system ahead of its planned meeting with GP negotiators.

But Dr Richard Vautrey, deputy chair of the GPC, dismissed the fresh allegations as ‘complete nonsense' and said there was no suggestion practices were inappropriately exception reporting.

‘We have concerns about the emphasis on exception reporting as being fraudulent or gaming. Independent research evidence completely refutes that.

‘If there is any practice that is a significant outlier in terms of the way they exception report, then that is an issue for the PCT to deal with, but the suggestion that all GPs are gaming the system is complete nonsense.'

A Pulse investigation in June found one is six trusts had docked points from outlying practices and many others had launched investigations to expose gaming. PCTs have also begun to compile exception reporting league tables for diabetes.

Department of Health has asked NHS Employers to begin talks on reform of exception reporting

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