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Ministers to scrutinise GPs’ clinical reasons for exception reporting in new crackdown on QOF ‘gaming’

Exclusive The Department of Health is preparing to launch a renewed clampdown on exception reporting by scrutinising in detail GPs' clinical reasons for excepting patients, as well as the proportion of patients excluded from the QOF.

Pulse has learned that ministers have asked QOF data experts at the NHS Information Centre to collate information on exception reporting that shows the clinical reasons GPs exception report patients, in order to flag up practices and individual GPs they suspect of gaming.

Currently, the NHS Information Centre collects and publishes data on the total number of patients exception reported, by clinical indicator and by practice – but the statistics do not include a breakdown of the reasons for which patients are exception reported or excluded from QOF payment calculations.

BMA guidance on exception reporting states that, because QMAS and other QOF achievement analysis systems only record exception reporting against a limited number of codes, ‘it is not possible to extract accurate or meaningful data on exceptions broken down by each of the criteria from national systems. The UK countries will therefore only report the total numbers of patients excepted for each indicator.'

But a source close to the Department of Health team told Pulse that ministers are keen to analyse exception reporting data available down to the level of the specific reason given for each patient, as they believe this will help identify GPs who are gaming, and ‘have asked the NHS Information Centre if it is possible to analyse exception reporting reasons to identify if and where GPs are cheating'.

A spokesperson for the NHS Information Centre said: ‘We have been asked for raw data on the different clinical reasons GPs exception reported patients, and this has been supplied, for a piece of work for the DH.'

But GPC deputy chair Dr Richard Vautrey said more detailed information on exception reporting would be of little additional value.

He said: ‘It will completely misrepresent the data and give a false impression. Most of the data about exception reporting is included in free text as well as coded data. If for example a GP exception reports a patient on the grounds of a particular concern that a patient has got, it may not be appropriately reflected in a Read code.'

‘This is another demonstration of how obsessed the Department of Health is about exception reporting despite repeated evidence that it is being done for legitimate reasons.'