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Gold, incentives and meh

Little gaming in exception reporting

With regard to your story 'Practices with outlying exception reporting rates face fraud investigations', perhaps the civil servants at the Department of Health would care to read the report in the New England Journal of Medicine 'Exclusion of Patients from Pay-for-Performance Targets by English Physicians' (17 July 2008 359:274-84).

This independent and objective study analysed QOF data from 96% of all practices in England for 65 clinical activities.

The authors, from the National Primary Care Research and Development Centre, concluded: 'Exception reporting brings substantial benefits to pay-for-performance programmes, providing that the process is used appropriately.

'In England, rates of exception reporting have generally been low, with little evidence of widespread gaming.'

From Dr Craig Wakeham, Dorchester, Dorset

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