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. Within PCAS the reasons used to except patients are all classed as exceptions, however, for the purposes of this publication we have agreed 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.