The Quality & Outcomes Framework includes the concept of exception reporting. This has been introduced to allow practices to pursue the quality improvement agenda and not be penalised, where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contra-indication or side-effect. Patients are not excepted from disease register counts (i.e. Indicator 1 in each clinical area), but they can be excepted from the denominator of subsequent indicators in each clinical area.
The Payment Calculation and Analysis System (PCAS) implemented functionality for exception reporting in late 2005. Prior to April 2006, a total of 49 reasons could be used to except patients from the denominators of indicators. With the introduction of new clinical areas and new indicators, there are now 121 exception reasons. Within PCAS these reasons are all classed as exceptions, however, for the purposes of this publication we have agreed with UK colleagues a distinction between those that are true exceptions and those that are actually exclusions (see Exception/Exclusion Lookup). Exclusions refer to reasons that make the patient ineligible for inclusion in an indicator's denominator, for example, because they do not meet the age requirement of the indicator.
Presented here are exception and exclusion rates in respect of general practices for indicators within the clinical domain. In addition, exception rates are available for Cervical Screening.
A bulletin summarising exception reporting data is also available.