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Ministers 'to scrap QOF exceptions'

Department of Health 'increasingly suspicious' that some GPs are gaming to hit targets

The Department of Health plans to scrap exception reporting amid concerns a section of GPs are gaming to hit targets, Pulse can reveal.

The move opens up a new front in the campaign to clamp down on GP pay – in the same week Government negotiators said they would consider imposing a cap on practice profits.

An adviser on the quality and outcomes framework told Pulse ministers wanted to cancel exception reporting, but maintain a '10 per cent leeway' – probably by holding maximum thresholds at 90 per cent.

A second Pulse source within the department described exception reporting as a 'bugbear', and confirmed ministers were considering an alternative with 'less flexibility and more auditing rights'.

The department denied any change was imminent. A spokesperson said: 'There are no plans to discontinue QOF exception reporting, but we keep the whole of the QOF under review with a view to continuous quality improvement.'

It is likely that any change would be part of the planned overhaul of the QOF in 2008.

Dr Chris Town, former lead negotiator for NHS Confederation, said ministers had become increasingly suspicious over the past few months.

'There's a sense at the department and NHS Employers that some PCTs have accepted high exception reporting. The BMA said when the QOF started that few GPs would achieve maximum points – but a lot did. It's not surprising exception reporting is now being questioned.'

New data obtained by Pulse show average 2005/6 exception reporting rates at 5.9 per cent – similar to the previous year.

But Dr Tim Doran, research fellow at the National Primary Care Research and Development Centre, who compiled the data, said rates at some practices were far higher.

'There is evidence a small proportion of practices are gaming in order to achieve targets. Practices in some places are doing lots of exception reporting – in some cases up to 80 per cent.'

Rates were highest in COPD at 7.6 per cent, CHD at 8.1 and mental health at 9.1 – areas where the loss of exception reporting is set to bite harder.

Dr Doran's team is working with PCTs on ways to spot gaming practices – and suggested any with a rate over 15 per cent warranted investigation.

But the BMA insisted exception reporting was 'fundamental' to the QOF.

Dr Stewart Drage, GPC negotiator, said given the current atmosphere he was not surprised by the rumours: 'If they have any intention to do it, they are going to be doing it to us rather than with our agreement.'

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