Practices with extremely low or high rates, generally have small numbers of patients. For example, if there is only one patient and that patient is exception reported, then the rate will be 100 per cent. If that patient is not exception reported the rate will be 0 per cent. The highest exception rate for practices with substantial numbers of patients are almost always substantially below 100 per cent.
The exception rate for coronary heart disease (CHD) 8 for England in 2007-08 was 8.96 per cent. (compared with a rate of 5.26 per cent. across all indicators). The interquartile range of practice level exception rates for CHD 08 was 5.21 per cent. to 11.28 per cent.
There is evidence that some practices, whether in deprived or more affluent areas, are using exception reporting inappropriately. Manipulating quality and outcomes framework (QOF) data in order to increase rewards without delivering the required level of quality for patients is clearly unacceptable—and also unfair on the majority of practices who comply with QOF requirements. Primary care trusts are responsible for verifying evidence of achievement. They should analyse exception rates and recorded prevalence, investigating any outliers, correcting payments where necessary and taking action if they uncover any actual fraud.
The Government are committed to ensuring in consultation with the profession, that QOF continually develops and supports leading edge quality of care for patients based on best available evidence. We will look at exception reporting and prevalence recording patterns as part of that process.
A copy of a list of exception reporting by practice on CHD has been placed in the Library.