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Gold, incentives and meh

NHS figures refute gaming claims

Rates of exception reporting are low overall but as high as 25 per cent for certain indicators, the first official analysis shows.

The average overall exception reporting rate was just 5.55 per cent, with only a tiny proportion of practices having rates experts have characterised as 'suspicious'.

Insiders told Pulse in January the Department of Health was desperate to scrap exception reporting, but the new figures do not appear to give ministers the excuse they are looking for.

There was, however, 'considerable variation' in the amount of exception reporting at different practices, ranging from 0 to 28 per cent.

The department's report concluded: 'In general, the lowest exception rates are observed in relation to indicators that measure a process, such as recording smoking or blood pressure.

'The highest exception rates are observed in relation to indicators that measure outcome.'

Exception reporting rates hit 99 per cent for certain indicators at a few practices, although only 52 practices (0.6 per cent) had average rates over 15 per cent.

Dr Tim Doran, a leading expert on exception reporting and research fellow at the National Primary Care Research and Development Centre, said: 'The suggestion is that less than 1 per cent of practices are over the 15 per cent level. If you're over that there's a suspicion of gaming.

'I don't think it supports the argument there's widespread gaming. If they wanted to use the data as an argument to do away with exception reporting it doesn't support that.'

The indicator with the highest level of exception reporting was CHD10 – the percentage of CHD patients treated with

ß-blockers – where huge numbers of patients with contra-

indications have led to a

total 24.9 per cent rate.

In indicators which would be most prone to gaming, no evidence of malpractice was found. BP5, for treatment of blood pressure in hypertension, did not make the top 10, despite the large numbers of points available.

Dr John Guy, a GP in Hatfield Peverel who analyses QOF data for Essex, said the variations

in exception reporting rates should not arouse suspicions.

'Practice populations do vary. To take it out would penalise doctors with particular case loads. My experience is there's little active exception reporting – it's the systems doing it automatically.'

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