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Don't blame GPs for 'inflated' exception reporting after threshold hike, says BMA

QOF exception reporting guidance should be revised so GPs are not blamed for ‘inflated’ exception reporting rates if the Government proceeds with its plans to hike upper thresholds, says the BMA.

The official BMA submission to the consultation on the Government’s planned changes to the GP contract in England warns that practices should not be held responsible by the media, PCTs and politicians if exception reporting rises from April, when the upper thresholds for 20 QOF indicators will rise to the achievement of the top 25% of GP practices.

It also warns they may be forced to focus on patient with health concerns linked to QOF and DES achievement in order to retain its current funding level, leading to reduced access for other patients.

The submission says: ‘The GPC and, we understand, the Department of Health expects exception reporting to have to rise as a consequence of the threshold changes in QOF.

‘The way the media, PCTs and politicians have handled exception reporting in the past has been profoundly unhelpful and the GPC does not want to see practices forced to justify exception reporting rates inflated as a result of these changes.

‘We suggest that, if these changes go ahead, the joint NHS Employers and GPC guidance on exception reporting should be revised and reissued to reflect the impact on clinical practice of the new thresholds.’

GPC deputy chair Dr Richard Vautrey said: ’We want a clear commitment from the Government that it is acceptable to exception report.

‘What has tended to happen over the last few years is that PCTs have used high exception reporting levels as a form of management question and they have investigated practices with higher level of exception reporting. We don’t think that is acceptable in the future.’

The submission further warned that reaching for thresholds set as high as 90% lead to GPs focusing on the achievement of thresholds rather than patient needs.

It read: ‘It would also impact disproportionately on access for non-QOF consultations, as priority may understandably be given to those most likely to allow the practice to achieve these targets.’

To which Dr Vautrey commented: ‘They made the mistake in Mid Staffs, why make the mistake again of focusing on targets above patient care? We know that if the systems are wrong, then mistakes are made. Even with the best intent of clinicians or those working within the system. If the system leads you towards working in the worst ways, then there is a risk that that might happen.’

Dr Peter Swinyard, chair of the Family Doctors Association, said: ‘I think most of us realise that the proposed imposition is actually potentially going to be extremely bad for patients and have some unintended consequences of causing us to focus on patients that make us money, patients that come with QOF targets, rather than patients with conditions that are harder to measure but are much more important to treat. I think we have to remember that not all that is measurable is good and not all that is good is measurable.’

Readers' comments (11)

  • And every year there is an improvement the upper threshold will get higher until it is virtually 100%, making it unworkable, which was never the intention of nGMS.
    A contract renegotiation is needed, however the BMA has no leverage with the government to make its own "imposition".
    However a perfect storm is approaching with the epideomological bulge of older GPs seeking earlier retirement and younger doctors not being foolish enough to join practices that will become short of income and have unfilled GP positions.
    I dont know what HMG can then do to save primary care from the recruitment crisis.

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  • Don't you understand the Tories created a problem in dentistry in the early 1990s deliberately, the result private practice ,they are doing the same again, all we are arguing about is the detail ,the core policy is the same, the destruction of NHS care.the nasty party rides again!they only have 2 years left GPs across the country need to stand for the NHS against them at the next election.that will get their attention.

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  • I am 56 years old and retire 6 weeks today. No revalidation, CQC or CCGs for me I'm afraid. Could have easily worked longer but want to hopefully have quite a few reasonable years left as an ex GP only being concerned about my own health and not that of the health consumers I see each day.

    In my time as a GP I can honestly say the RCGP has had NO RELEVENCE WHATSOEVER in my daily practice. I don't consider myself to be a great GP just an average one, doing my job to the best of my ability and treating people like I would like my kids to be treated in the future.

    I really couldn't care less about their role in General Practice it has little or no importance in day to day practice. It would be rather ironic if an organisation which claims to be putting medicine first was found guilty of being racist.

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  • Vinci Ho

    Here we go.
    Extraordinary time .Extraordinary events.
    As I said before ,together with everything happening to general practice at the moment, this is one hell of a critical time as far as history of general practice in this country is concerned.
    It is about benevolence ,fairness,impartiality ,justice ,courtesy ,wisdom to distinguish between right and wrong(black and white), and gaining trust through openesss ,honesty and transparency.
    Once JR is started ,these leaders from both sides will have to keep quiet in public.. Neither side is probably have full advantage to win the legal battle.
    I hope the reputation of the whole profession would not be too seriously damaged at the end. But then again ,if this could represent a revolutinary time in the history,let it be...........

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  • I am 57 and plan to soldier on doing 9 sessions a week for at least the next three years. So do enjoy your hard earned retirement. But like most of general practice, your own experience of it and perception of what it is is very much individually determined- you reap what you sow. You mention you don't see yourself as a great GP, just an average one. Modesty is always a essential trait for us, but for many their working lives have been transformed by a vision of what general practice is and what it can become by the efforts of 'great' GP's who contribute to the RCGP (of which i am not one), so my message to training GP's is that its your college, once you have passed the dreaded CSA and its your future. Good luck with your exams and to my retiring colleague thanks for sharing your thoughts.

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  • @rcgp , solution(s) are very easy to find and implement as long as 'sincere' and 'honest' intentions are present.
    If someone is unable to accept the flaws, then obviously there is no way other than JR.

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  • What a load of rubbish. This is sour grapes by those who cant pass the exam. Its clear the training period is 3 years and you have to pass the exam. Unfortunately those who havent been submerged in the UK culture for long enough say 6 years or so have a mountain to climb in 3 years. They have the same failure rate in the AKT and thats marked by a machine.Should we dscriminate in favour of them and dumb the exam down?
    I may not always have agreed with the college but it has raised standards. We dont want to continue having hospital failures in General Practice. This exam is much more exacting than previously and I suggest not as subject to bias as the other colleges.
    There will be failures. Otherwise dont bother lets just let everyone through and not bother with standards.

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  • I am a newly qualified GP and had gone through AKT and passed my CSA in first attempt. I happen to be a International Medical Graduate from Dow Medical College in Pakistan.
    In my personal opinion CSA exam is just simply based on how good actor you are and less in your clinical knowledge but it has an element of checking how safe you are at the same time. Many of my colleagues who failed this exam with whom I studied even is that this exam checks tour communication at its highest level and is lenient on check clinical knowledge. This exam in my opinion has some flaws and needs to have a video recording of stations to be assessed if in doubt for a second opinion as should be other exams. Racism doest exist in the profession overall from actual day to day clinical practice to assessments in exams ( which only the person who has been a victim of racism in their own life can feel and the same rule applies to bullying ).

    This exam should at least allow candidates to attempt exam again even if they have finished their training but are clinically active be it in hospital posts. Also at the same time duration of GP training needs to be increased to 5 years and if not possible due to financial reasons then shorter rotations in more relevant specialities like in USA. Most of the GP candidates end up doing rotation in specialities to fill rota gaps rather than their needs. Programme directors needs to have more involvement in the training and GP's who have gone through this exam and assessment need to be made associates with Programme directors

    I have faith in the justice system of UK and hope whatever is in the best interest of profession happens as an outcome of this legal battle.

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  • @stephen 9:48
    It seems that you have got a bit of knowledge gap regarding CSA issue.
    You said
    "There will be failures. Otherwise dont bother lets just let everyone through and not bother with standards"
    Exactly, you seem to be contradicting yourself. There are bound to be failures in any exam. So how come, one cohort of candidates has got 100% pass rate and the failure is just from the other cohort. As you said, why bother with the first group who are going to pass anyway no matter how they perform!!!

    No one is asking to lower the standards. Its about fair and equal treatment. Its about giving 9/9 to all candidates who have not made a mistake at a station, not giving 6/9 to IMGs and 9/9 to the other favorable group. Its about actors behaving the same way with all candidates and examiners marking you the same way. The issue is about fairness and equality, having the right to appeal when you know you are right!

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  • Like the saying goes "if you can't stand the heat in the kitchen then get out"

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