Exception reporting is highest in CKD domain

The rate of exception reporting of patients by practices in England rose slightly last year.

The overall rate of exception reporting in England in 2006/7 rose to 5.83 per cent from 2005/6's figure of 5.55 per cent, according to data from the DoH's Information Centre published this week.

Although the quality framework indicators changed in 2006/7, exception rates in unchanged indicators still increased slightly.

The chronic kidney disease (CKD) indicator for lowering BP to 140/85mmHg had the highest exception rate of any individual quality framework indicator at 29.7 per cent.

Dr Sarah Jarvis, west London GP and member of the Primary Care Cardiovascular Society, said GPs should be congratulated for treating patients on a case-by-case basis.

The BP indicator for CKD is flawed, she said. 'It does not differentiate between elderly and younger patients and I don't think it is appropriate to be trying to lower the BP of elderly patients with stable kidney function.'

The exception rate for treating patients at risk of secondary CHD with beta-blockers was also high at 27.8 per cent.

'Given that there is a lot of anxiety about prescribing beta-blockers to CHD patients I think that is entirely appropriate,' said Dr Jarvis.

Mental health was the domain with the highest number of exception reports. This is probably due to the introduction of indicators for reviewing patients with schizophrenia and bipolar disorder, say the report authors.

Regionally, London SHA had the highest overall exception reporting at 6.24 per cent.

Dr Jarvis said that London's transient population meant shorter relationships between GPs and patients, making them less likely to comply with treatments.

The North East had the lowest rate of exception reporting at 5.51 per cent.


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