Exception Reporting

Exception Reporting is the process by which patients are excluded from the Quality and Outcomes Framework (QOF) targets to ensure practices are not penalised, due to, for example, patients declining treatment, procedures or having contra-indications.

Exception details display at each individual indicator level and are submitted automatically.

Practices are able to compare their level of exception reporting against organisational and national averages. The rates display in a summary form based on five exception categories:

  • Quality indicator care was unsuitable
  • Declined quality indicator care
  • Registration date
  • Diagnosis date
  • Other

ICS/Health Boards can examine details for each individual indicator, aggregated for the practices within their locality. They can also examine exception details compared with the national rates.

Domain and Indicator Specific Expiring Exceptions

There are two levels of exceptions for each clinical category:

Top Level - Domain Specific

These usually apply to all indicators within each category:

  • Quality indicator care was unsuitable
  • Declined quality indicator care

These must be recorded annually.

Indicator level

Apply to individual indicators only, for example:

  • Maximum tolerated medication dosage
  • Drug allergy / contraindication
  • Patient recently registered
  • Patient recently diagnosed
  • Treatment / procedure declined

Drug allergies and adverse reactions only need to be recorded once in the patient records, these are called 'persistent exceptions'. Other exceptions must be recorded annually and are called 'expiring exceptions'.

Training Tip - For a CHD patient taking aspirin, another antiplatelet or an anticoagulant, contraindications to all three drug groups must be recorded for them to be excepted from these indicators. They can, however, be a mixture of persisting and expiring contraindications. For example, aspirin allergy (persisting), clopidogrel not tolerated (expiring) and warfarin declined (expiring). So the clopidogrel not tolerated and warfarin declined should be recorded annually. Similarly, for STIA007 where additionally dipyridamole must be recorded as a fourth option.
The same underlying rule applies to ACE inhibitor / A2 antagonist therapy (HF03, DM06). Patients not taking either of these two drugs need contraindications recorded to both drug groups. Again, one can be 'persisting' and the other one 'expiring'.

Audits for Exception Reporting

The Data Quality Audits, include audits for expiring exceptions. These can help you identify patients whose last exception of this type is in the previous QOF/QAIF year:

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