Birmingham University Professor Helen Lester, who leads the piloting of potential QOF indicators on behalf of NICE, worked with colleagues to examine exception reporting in English GP practices in 2008 and 2009.
There were wide variations, across indicators and practices, in exception reporting rates. For the CKD2 indicator 0.5% of patients were exception reported, but for the stroke indicator STR13 19.8% of patients were excepted.
These variations need to be studied in more detail, the researchers said. For instance, high exception reporting rates for some QOF indicators raise questions about the appropriateness of these targets, they argued.
For most indicators less than 2% of patients were excepted for informed dissent. The researchers argue that this suggests that the activities incentivised by QOF are broadly acceptable to patients. They note, however, that this does not imply that patients approve of the system itself.
‘Exception reporting [provides] some protection from inappropriate and coercive treatment of patients whose providers are subject to financial incentives,’ the researchers said.
‘At relatively low cost, the provision to exception report enables patients’ voices to be heard and counters some of the critiques of the scheme as endangering the doctor-patient relationship.’