The publication of exception reporting data for the Quality and Outcomes Framework will reveal total numbers of patients excepted for each indicator but not the reasons behind the decisions.
In new guidance on exception reporting NHS Employers and the British Medical Association say the software used to calculate practices’ performance in the QoF, such as the Quality Management and Analysis System (QMAS) does not separately identify each of the nine allowable reasons why patients have been excepted.
The guidance says that, for example, two of the nine reasons are both coded as ‘informed consent’ and although a patient is only excepted once by the system for each indicator a patient’s record could contain more than one kind of exception code entered by the practice.
The guidance adds: “It is therefore not possible to extract accurate or meaningful data on exceptions broken down by each of the criteria defined in the SFE [Statement if Financial Entitlements] from the national systems. The UK countries will therefore only report the total numbers of patients excepted for each indicator.”
The guidance says new advice has been issued because “it has become clear that a variety of interpretations and applications of the nationally defined exception reporting criteria are possible.”
The supplementary guidance, which applies from April 2006 and is intended to ensure a consistent approach from GP practices, primary care trusts and QoF assessors,
looks in detail at each of the nine legitimate reasons for exception reporting. The guidance makes it clear what is acceptable practice and what is not. The guidance says it is not acceptable to:
• use a generic invitation on the right hand side of a prescription to attend for, for example, flu vaccination.
• put up a notice in the waiting room inviting particular groups of patient to attend (for example for flu immunisation).
• use blanket exclusions on the basis of age or diagnosis to except patients from chronic diseases parameters, for example patients suffering from dementia or cancer.
• exclude patients on the basis that they are on maximum tolerated doses of medication and whose levels remain sub-optimal simply because they are under the care of a consultant.
• except a patient on the basis a secondary care service is unavailable, without the agreement to use exception reporting in those cases from the primary care organisation’s medical director.
The guidance says the overriding principles to follow in deciding to except a patient are that the duty of care remains for all patients irrespective of exception reporting, that it is good practice to review patients who have been exception reported from time to time, that the decision to exception report should be based on clinical judgment and that there should be no blanket exceptions.
QoF data for all four countries has now been published but a spokesperson for the Information Centre which publishes the data in England, told EHI Primary Care last month that publication of exception reporting figures is pending agreement with the other three countries on how the data will be extracted.
Links
Guidance on exception reporting