Changes to the payments software for the Quality and Outcomes Framework mean practices and primary care trusts will be able to check exception reporting details on the system from this autumn.
Connecting for Health has announced changes to the functionality of the Quality Management and Analysis System (QMAS) including the addition of exception reporting information.
Exception reporting is the process by which patients are excluded from QoF targets, such as flu vaccinations, if they are unsuitable or contra-indicated, to ensure practices are not penalised. Concerns have been raised though that GPs have been excluding too many people in order to hit targets.
Most of the pressure to add detailed information about exception reporting activity is believed to have come from PCTs as part of a drive to put the number of patients practices exclude from Quality and Outcome Framework indicators under closer scrutiny.
However the British Medical Association’s General Practitioner Committee says it did not oppose the move.
A GPC spokesperson told EHI Primary Care: "As long as practices are using the exception reporting methods appropriately there will be no problem. In fact the greater information should help practices to justify their exception reports if required by subsequent audit by having more evidence to offer."
Connecting for Health says it will be possible for practices to submit exception reporting details from October but the availability of the facility will depend on the roll-out plans of GP clinical system suppliers. After roll out practices that make automated clinical submissions to QMAS will submit exception details to the system.
QMAS will collect information on ‘exception reasons’, such as recent registration and the type of exception code recorded together with ‘counts of exception reasons’ which will show the number of instances within that practice of that ‘exception reason’.
Exception details will be recorded at each individual indictor level in the clinical domain and for several indictors within the non-clinical domains such as cervical screening.
Practices will be able to compare their level of exception reporting against PCT and national averages with rates displayed in a summary form based on five generalised categories of exceptions, patient unsuitable, informed dissent, registration date, diagnosis date and other. More detailed information about reasons for exception reporting will also be available.
At PCT level trusts will be able to examine details for each individual indictor , aggregated for the practices within the PCT. The PCT will also be able to examine exception details at indicator group level, for example for coronary heart disease, compared with the national exception rates for the same indicator group.
Dr Gavin Jamie, a GP in Swindon, Wiltshire who plans to put QoF data for all UK practices online (www.gpcontract.co.uk), says the addition of exception reporting is a reflection of plans to expand the use of QMAS.
He told EHI Primary Care: “There is more and more pressure to use QMAS as a monitoring tool as well as a payment tool so most of the pressure to do this will have come from PCTs.
“However I am always being asked if I have exception reporting figures as at the moment practices have no idea what the average level of exception reporting is so it will be useful for GPs to see that data.”
Connecting for Health says that individual practices will not be able to see another practice’s exception reporting details but Dr Jamie believes that the information could appear next year as part of the release of data under The Freedom of Information Act.
He adds: “Its difficult to see how they could withhold it although a lot of it may end up not being released because where the numbers of patients involved are small the figures will probably not be released to preserve patient confidentiality.”
A number of other smaller changes are being made to the reporting layouts on QMAS mainly to help practices and PCTs to understand the disease prevalence figures, particularly at year end.
QMAS will now show raw disease prevalence values at practice, PCT, strategic health authority and national level rather than the square root figures that were displayed in the first year.
Connecting for Health says raw disease prevalence values will be calculated at the start of every month and has reminded PCTs and practices that QMAS uses practice list sizes provided by the Exeter system at the start of each quarter. The latest bulletin from the QMAS team emphasises that practices and PCTs should ensure practice list sizes are correct on Exeter before capitation work, including the global sum, is completed.
More than 20,000 users have so far registered with QMAS and in the last financial year QMAS oversaw payments of more than £1 billion in achievement and aspiration payments to practices.
Dr Mike Robinson, medical director of InPractice Systems, said the company planned to release an update to Vision to support the reporting of exceptions of patients from QOF to QMAS in about October this year.
iSOFT said its QMAS software will be rolled out in several releases: an initial release for pop-ups will be followed later in the year by a release for exception reporting.
A spokesperson for EMIS said it estimated that the coding will be complete for the first week of September. She added: “The software amendments will be patched out after formal CfH conformance testing has approved the changes. We are currently awaiting dates from CfH for when they will carry out the conformance testing.”
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