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Quality scheme had to crack down on exception reporting

GPs working in a prototype of the quality framework have seen their levels of exception reporting cut to a 'bare minimum' after a crackdown by assessors, Pulse has learned.

Leaders of the Primary Care Clinical Effectiveness ­ or PRICCE ­ project in east Kent detected 'significant levels' of GPs using exception reporting as a loophole to achieve pay targets when the scheme began seven years ago.

PRICCE was the prototype for the quality framework and its deviser Dr Tony Snell was the lead NHS Confederation negotiator on the framework.

Margate GP Dr John Heather, chair of the PRICCE steering group, said assessors now checked every single exception report of every GP.

One area of concern was the failure of some GPs to distinguish between poor compliance and informed dissent, meaning GPs might need written statements from patients to prove informed dissent, he added.

'Diabetes is an area of non-compliance, where people were turning up but where they were eating cream cakes or were not making the lifestyle modifications. You could get a written statement to say "I insist on eating cream cakes".'

But GPC negotiator Dr Laurence Buckman said: 'PRICCE was very draconian. GMS2 will not be as arduous.'

Dr Snell said GPs would need to be educated about when exception reporting was justified as the quality framework was one of the biggest risks to the high-trust culture of the new contract.

He said: 'There were very significant levels of exception reporting when PRICCE was new because people were trying to understand what was possible to exception report. The amount has diminished to a bare minimum.'

Dr Snell said PCTs would need to 'carefully analyse every single exception report' in annual practice statements of quality and outcomes performance. Trusts would have the right to ring up patients to check they had given informed dissent, he added.

But Dr Ian Trimble, a senior Government adviser on the quality framework and a GP in Nottingham, said checking every report would be 'too intrusive'. He said checks would only be necessary for practices with high levels of exception reporting.

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