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Exception reporting expected to rise as GPs face stricter QOF thresholds

GPs will be at risk of losing thousands of pounds unless they substantially raise their performance against QOF indicators after the decision to raise upper and lower thresholds along the lines of controversial recommendations from NICE.

Upper thresholds were raised by five points for 13 clinical indicators covering coronary heart disease, primary prevention of cardiovascular disease, stroke, heart failure, dementia and COPD. The  blood pressure threshold for hypertension was raised from 70% to 80%.

Lower thresholds were raised by five or 10 points for 56 indicators, with all 40% to 90% ranges changing from 50% to 90%, and lower limit raised from 40% to 45% for indicators where the upper threshold was between 70% and 85%.

NICE said in July that ‘arbitarily set' payment thresholds were no longer serving their purpose and suggested raising upper thresholds to the 75th centile of performance and lower thresholds by 5% – but admitted the move would have major implications for GP pay.

A subsequent study found a quarter of GP practices would lose an average of £5,000 under the move unless they substantially raised achievement levels.

Dr Gavin Jamie, a GP in Crawley, Sussex, who runs the QOF Database website, said changes to the top thresholds would have the largest impact, and warned of an increase in exception reporting: ‘Where they have increased the top indicator that will certainly make things harder. We may well see more exception reporting just to get to the new thresholds.'

But the Department of Health recently asked the NHS Information Centre to collate data on the clinical reasons for exception reporting as part of a clampdown, and warned there should be no increase in response to the toughened indicators.

‘The purpose of raising thresholds is to ensure more patients benefit. GP practices should not increase the proportion of patients exception reported.'

Dr Tim Cantor, a GP in Kent, said: ‘A lot of practices are quite wary about being seen to be manipulating data, and may be doing themselves down.'

Dr Bill Beeby, chair of GPC prescribing committee and a GP in Middlesbrough, said: ‘There's a possibility some people will have an exception report put in legitimately where previously it wasn't necessary. If you had already hit that target, there would not have been any point in putting in an exception report, but if the target is stricter, you may be more likely to do it.'