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PCT exception attack

By Helen Crump

PCTs have revealed plans to take a tougher stance on exception reporting this year, even targeting GPs who have not broken any rules.

Quality framework leads at trusts said checks had been given a high priority because of significant differences in levels of exception reporting between practices.

The approach comes despite research (Pulse, 9 March) which found only 80 to 200 practices may have 'gamed' exception reporting, less than 1 per cent of the total.

Julie Bolus, director of clinical development at Leeds North East PCT, said it would challenge GPs who had exception reported large numbers of patients, even if they had acted within the rules.

She said the trust wanted GPs to stop exception reporting difficult-to-reach patients who had failed to attend on more than one occasion after being called in.

Mrs Bolus said: 'We wanted practices to use exception reporting in an ethical way where they firmly believed they had tried everything to achieve high quality.'

Exception reporting rates ranged from 0 per cent to 80 per cent for the asthma 7 indicator, she added.

GPs who excepted more than 50 per cent of patients were asked to provide evidence for their actions and challenged over whether patients would understand what they were being offered, Mrs Bolus said.

Hastings and St Leonards and Bexhill and Rother PCTs have adopted similar approaches. A spokesman for the two trusts said: 'If there was a practice that looked high, it would be addressed at the time of the review.'

Dr Laurence Buckman, GPC negotiator for the QOF, said it was reasonable for PCTs to ask how a practice had reached an exception report, but 'grilling' GPs was not acceptable.

'If this turns into policing then it's not OK and that depends on the tone of voice the question is being asked in and the attitude to the response.'

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