Clampdown on QOF exception reporting ‘not justified’

By Lilian Anekwe

GPs have been exonerated from accusations of 'gaming' the QOF though increasing exception reporting by a new NHS-funded evaluation.

A study by researchers at the London School of Hygiene and Tropical Medicine evaluated the impact of QOF on public health and health inequalities.

It concluded that practices are not using QOF exception reporting and prevalence adjustments to game the QOF, and that PCTs should not be encouraged 'to use information about levels of exception reporting to target those practices with high levels that cannot be justified clinically.'

GPs have been subject to repeated accusations of fraud and manipulation of prevalence and practice data in order to gain financially from the QOF, with previous academic evidence forming the basis of clampdowns by PCTs to dock practices of QOF points gained from unacceptable levels of exception reporting.

Overall QOF exception-reporting rate rose from 4.87% in 2008/9 to 5.14% in 2009/10, according to the latest figures published by the NHS Information Centre covering over 8,000 practices in England.

Pulse reported in October that the Department of Health was considering withdrawing GPs' ability to exception report patients, but this has since been watered down to a pledge to introduce tighter scrutiny of GPs' exception reporting and reported prevalence levels to prevent the QOF being 'undermined' once it is revamped to focus on outcome targets.

The study, commissioned by the NHS National Institute for Health Research, was based on analysis of routine data and interviews with practice and PCT staff and assessed the extent to which QOF has contributed to improving health in deprived areas of England.

The average level of exception reporting 'masks wide variations in practice', the analysis found, but the contribution of exception reporting to high levels of QOF achievement 'is very small'.

The researchers included Anna Dixon, director of policy at the King's Fund, and Dr Stephen Gillam, a GP in Luton, Bedfordshire and consultant in public health at the University of Cambridge.

Dr Gillam concluded: 'Recent efforts have been made to encourage PCTs to use information about levels of exception reporting to target those practices with high levels that cannot be justified clinically. The fear is that these practices, particularly in deprived areas, are using exception reporting to exclude challenging patients.'

But the report found: 'However, analysis of subsequent years suggests that at least part of the reason why some practices are achieving higher reported achievement is because of higher levels of exception reporting; however, the contribution is very small.

The analysis also found little evidence of practices gaming by not putting patients on the disease register. It concluded: 'Practices are not gaming by failing to register patients. A more likely explanation is that well-organised practices that are able to achieve better QOF scores may also be more systematic in their approach to case-finding.'

Click here for Dr Gavin jamie's tips on avoiding pitfalls in QOF exception coding