Exception Reporting

Exception reporting is the process by which patients are excluded from QoF targets to ensure practices are not penalised, because patients decline treatment/procedures or have contra-indications etc.

Exception details display at each individual indicator level and submit 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:

  • Patient unsuitable
  • Informed dissent
  • Registration date
  • Diagnosis date
  • Other

CCG/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 apply to ALL indicators within category.

  • Patient unsuitable
  • Informed dissent

These must be recorded annually.

Indicator level

Apply to individual indicators only.

  • 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.

Note - CHD patients taking aspirin, another antiplatelet or an anticoagulant, contraindications to ALL THREE drug groups must be recorded for a patient to be excepted from these indicators. They can, however, be a mixture of persisting and expiring contraindications. eg 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 STROKE12 where additionally dipyridamole must be recorded as a fourth option.
The same underlying rule applies to ACE inhibitor / A2 antagonist therapy (CHD11, HF03, DM15). 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.