ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2011
Exception reporting in the Quality and Outcomes Framework: views of practice staff - a qualitative study.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- From exception to insight: a phenomenological study of quality managers' perspectives on the individual appeals in the National Healthcare Quality Program.Israel journal of health policy research · 2026Article
- The impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: results from a rapid scoping review.BMC primary care · 2025Article
- Ethnic inequities in the patterns of personalized care adjustments for 'informed dissent' and 'patient unsuitable': a retrospective study using Clinical Practice Research Datalink.Journal of public health (Oxford, England) · 2023Article
- Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years.BMJ open diabetes research & care · 2021Article
- GPs' mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Article
- A pay for performance scheme in primary care: Meta-synthesis of qualitative studies on the provider experiences of the quality and outcomes framework in the UK.BMC family practice · 2020Article
- Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Article
- Incentivised chronic disease management and the inverse equity hypothesis: findings from a longitudinal analysis of Scottish primary care practice-level data.BMC medicine · 2017Article
- Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study.BMJ quality & safety · 2016Article
- Performance of new alternative providers of primary care services in England: an observational study.Journal of the Royal Society of Medicine · 2015Observational
- Physical health indicators in major mental illness: analysis of QOF data across UK general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Article
- Increasing the QOF upper payment threshold in general practices in England: impact of implementing government proposals.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Article
- Article
- Ethical issues raised by the introduction of payment for performance in France.Journal of medical ethics · 2012Article
- Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework.BMJ (Clinical research ed.) · 2012Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundException reporting allows practices to exclude eligible patients from indicators or an entire clinical domain of the Quality and Outcomes Framework (QOF). It is a source of contention, viewed by some as a 'gaming' mechanism.
aimTo explore GP and practice staff views and experiences of exception reporting in the QOF. DESIGN OF STUDY: Qualitative semi-structured interviews.
settingInterviews with 24 GPs, 20 practice managers, 13 practice nurses, and nine other staff were conducted in 27 general practices in the UK.
methodSemi-structured interviews, analysed using open explorative thematic coding.
resultsException reporting was seen as a clinically necessary part of the QOF. Exempting patients, particularly for discretionary reasons, was seen as an 'exception to the rule' that was justified either in terms of practising patient-centred care within a framework of population-based health measures or because of the poor face validity of the indicators. Rates in all practices were described as minimal and the threat of external scrutiny from primary care trusts kept rates low. However, GPs were happy to defend using discretionary exception codes for individual patients. Exception reporting was used, particularly at the end of the payment year, to meet unmet targets and to prevent the practice being penalised financially. Overt gaming was seen as something done by 'other' practices. Only two GPs admitted to occasional inappropriate exception reporting.
conclusionException reporting is seen by most GPs and practice staff as an important and defensible safeguard against inappropriate treatment or over-treatment of patients. However, a minority of practitioners also saw it as a gaming mechanism.
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