Quality and Outcomes Framework - Exception Reporting

Exception Reporting

The level of achievement recorded depends on the GP treating the patients with the relevant problem. But not all patients are treatable or willing to be treated. In order for the GPs not to lose points on account of circumstances that are outside their control they can exclude those patients from counting towards their achievement by "exception reporting" them. Exception reporting is allowed for:

• patients who refuse to attend;
• patients for whom chronic disease reporting is inappropriate (e.g. terminal illness, extreme frailty);
• newly diagnosed or recently registered patients;
• patients who do not show improvement;
• patients for whom prescribing a medication is not clinically appropriate;
• patients not tolerating medication;
• patients refusing investigation or treatment (informed dissent);
• patients with supervening conditions;
• cases where diagnostic/secondary care service is unavailable.

Practices in Scotland have been found to use exception reporting appropriately in that patients who were older or who had dementia were more likely to have been "exception reported". However, younger or more socio-economically deprived patients were more likely to be recorded as having refused to attend for review or not replying to letters asking for attendance at primary care clinics. It has therefore been highlighted that primary care practices should identify and monitor these individuals (i.e. the youngest and most deprived with cardiovascular disease) so that all patients fully benefit from the implementation of the new GMS contract and receive appropriate clinical care to prevent further disability and mortality.