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Exception reporting checks to get tougher

By Lilian Anekwe

Exclusive: The Department of Health plans to introduce tighter scrutiny of GPs' exception reporting and reported prevalence levels to preventing the QOF being ‘undermined' once it is revamped to focus on outcome targets.

Figures published last week show the number of patients exception reported by GPs increased over the last financial year, following the introduction of several new and controversial clinical indicators in the 2009/10 QOF.

NHS Information Centre statistics for over 8,000 practices in England show the overall QOF exception-reporting rate rose from 4.87% in 2008/9 to 5.14% in 2009/10.

Pulse revealed last month that ministers were considering scrapping exception reporting, after receiving a report accusing GPs of abusing the system. The DH has now told Pulse it will keep the system for the time being, but tighten up the rules governing it and practice prevalence, which some GPs have been accused of artificially inflating to boost payments.

A DH spokesperson said: ‘We intend to reform the payment system so GPs are rewarded for improving patient outcomes. High exception reporting for outcomes can undermine accountability for performance. So, we will look closely at exception reporting and prevalence recording patterns as part of that process.'

The report by DH statisticians acknowledged the increase in this year's figures ‘is probably at least partly due to changes in the QOF, including introduction of new clinical indicators, in 2009/10'.

Four of the clinical domains in which new indicators were introduced in 2009/10 – COPD, depression, diabetes and heart failure - had increased exception reporting in 2009/10 compared with the previous year (see graph).

Exception reporting more than doubled from 8.01% to 17.2% in the heart failure domain, where a new indicator HF4 – for use of [beta]-blockers in patients on an ACE inhibitor or ARB – was introduced for 2009/10. Some 37.8% of patients were exception reported from this indicator.

DEP03, for further assessment of severity in patients diagnosed with depression, had 32.7% exception reporting. Overall exception reporting within the depression domain rose from 3.8% in 2008/9 to 6.05% in 2009/10.

And 12.9% of patients were exception reported for DM23, the controversial indicator rewarding GPs for reducing HbA1c to below 7% in patients with diabetes.

Paul Conroy, a practice manager in Colchester, Essex, said: ‘Rather than scrapping the scheme, perhaps we need to learn from what the high points tell us – that there are clinical problems with the process targets set for parts of the QOF that don't benefit outcomes. Mr Lansley take note.'

Heart failure domain saw exception reporting double