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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.’