Based on 37 indicators for which reasons for exception reporting were ascribable (see table 1).
Based on 37 indicators for which reasons for exception reporting were ascribable (table 1).
These indicators were excluded from all analyses relating to reasons for exception reporting.
Common reasons for exception reporting were logistical (40.6% of exceptions), clinical contraindication (18.7%), and patient informed dissent (30.1%).
The median exception rate across the 37 indicators for which reasons for exception reporting were ascribable was 2.7% (interquartile range 1.9-3.9 1.9-3.9
Table 3 gives the results of the regression analyses for the 37 indicators for which reasons for exception reporting were ascribable.
For the 37 indicators for which reasons for exception reporting were ascribable, 4.9% of remuneration received was attributable to exception reporting (£19 188 917 for all English practices, £2386 for the average practice, and £0.36 per patient).
Appropriate reasons for exception reporting have been agreed between the Department of Health and the British Medical Association and these are comprehensive (Table 1) [ 1]. 5.55% of patients were 'exception reported' by English practices in 2005/6 [ 6].
Given that patients excepted for informed dissent are effectively drawn from a subset of patients not excepted for other reasons, it is possible that the relation between deprivation and informed dissent would be stronger in the absence of other reasons for exception reporting.
The box gives permitted reasons for exception reporting, including logistical considerations (for example, recent registration of the patient with the practice), clinical reasons (for example, a contraindication to treatment), and patient informed dissent (that is, not agreeing to the investigation or treatment).
There are good clinical reasons for exception reporting, but after unsuitable patients have been exempted from treatment, there is no reason why all maximum thresholds should not be 100%, whilst retaining the current lower thresholds to provide incentives for lower performing practices.
