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.'


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