Exception rates prove GPs are not ‘gaming'

Low overall rates of exception reporting in 2005/6 showed GPs did not cheat to achieve high scores in the quality framework, primary care experts have said.

The overall exception rate for England, across all clinical indicators, was 5.6 per cent.

The highest rate was for cancer, in which 8.9 per cent of patients were exception reported. The lowest was hypothyroidism, which had an exception rate of just under 0.6 per cent.

A small number of practices had higher-than-expected rates of exception reporting. Total exception reporting rates were in excess of 15 per cent at 52 practices in England, and 444 exception reported more than 10 per cent overall. Fifteen practices exception reported less than 1 per cent overall.

The data was published last week by the Information Centre, a DoH agency responsible for quality framework data.

NHS Employers quality framework lead Dr Adrian Jacobs told GP he expected primary care organisations (PCOs) to investigate practices with high exception reporting.

‘There is no evidence of large-scale overuse of exception reporting. Where there are high levels, there can be perfectly reasonable explanations,’ he said. ‘It would be helpful to have PCOs publish details of why any of their practices had high exception reporting rates.’

Some DoH policy experts want to ditch exception reporting because they fear it is open to abuse, but Dr Jacobs said: ‘Making it clear that GPs are not gaming the system will make the case for keeping exception reporting.’

The highest rate of exception reporting for a clinical indicator was 24.9 per cent, in the CHD 10 indicator. Asthma 07 was the second highest at 18.8 per cent.

CHD 10 records the percentage of patients with CHD who are currently being treated with a beta-blocker, unless contraindication or side-effects are recorded.

GPC member Dr Trefor Roscoe said high levels of exception reporting were likely because beta-blockers were contraindicated for large numbers of
patients.

‘If the patient is asthmatic you wouldn’t prescribe it, and side effects are common,’ he said.

Asthma 07 measures asthmatic patients over the age of 16 who have received a flu vaccination. Dr Roscoe said many mild asthmatics did not need to be vaccinated, and many in this category would refuse it. This is a valid reason for an exception report.

‘I don’t think there’s any gaming. It would be more work than doing the quality framework properly,’ Dr Roscoe said.

At SHA level, there was little variation in levels of exception reporting. Northumberland, Tyne and Wear had the lowest rate of 5 per cent, while Hampshire and Isle of Wight was highest, with 6.2 per cent.

PCT exception reporting rates ranged from 3.8 per cent to 8 per cent, but the data does not identify PCTs by name.

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