TABLE OF CONTENTS

Introduction

The Ardens Manager QOF Dashboard displays exception rates, also known as Personalised Care Adjustments (PCA).


The QOF contract is designed to improve patient care and hold practices accountable for achieving specific quality outcomes. However, clinical guidelines are not always appropriate for every patient. Practices should not be penalised for making clinically decisions that result in an indicator not being met.


Exception reporting (PCA) allows practices to exclude certain patients from specific indicators or clinical domains for clinical reasons or circumstances beyond their control. 


How to use Exception Reporting

Patients can be excluded from various indicators or domains by a Personalised Care Adjustment (PCA). This will allow patients to be excluded from indicator denominators under various circumstances including:

  • Newly diagnosed or newly registered patients:
    Patients who are newly diagnosed with a condition or newly registered with the practice may not have had sufficient time to receive the interventions required by the indicator. Therefore, these patients are automatically excluded if they registered at your practice or have a new diagnosis within the preceding 3 months. 
  • Patient choice:
    If a patient chooses not to receive a specific intervention or treatment, the practice can exception report them. This is known as informed dissent and must only be used where a patient has expressly chosen not to receive a specific intervention or treatment. 
  • Clinical unsuitability:
         If an intervention or treatment is deemed clinically unsuitable for a patient (e.g., due to contraindications or side effects), the practice can exception report them
  • Service unavailability:
     If a necessary service or investigation is unavailable, the practice can exception report patients
  • No response to invitations:
    Domain specific invitation codes should be used when inviting patients to their Long-Term Condition Monitoring Appointments. Provided that the patient has had a minimum of 2 coded invitations in the financial year, at least 7 days apart, they will automatically be excluded from the indicator denominator.
     
Exception rates are used as a quality measure of the practice, and it's important for practices to understand how they are calculated and what factors contribute to them. Practices must be mindful of the rate of Exception reports and only use them where clinically indicated or for circumstances beyond control. For example, Informed Dissent can only be used if a patient has expressly dissented to providing information or receiving investigation and have had a clinical discussion about the risks associated with not engaging. It must not be used where patients have ignored invitations - Personalised Care Adjustments (PCAs) aim to exclude non-engaging patients. 

 

An area that CQC will review with practices on inspections is the QOF exception rates. The data for these is available from NHS Digital where you can search by practice and look at historical QOF data, including exception rates. 


Accessing the Reports

The reports can be accessed via the Contracts icon, then the QOF Dashboard option.



A full list of exceptions per domain/indicator can be viewed by using the Overview tab on your QOF Contract Dashboard (1). Alternatively, if you want to view domain specific exception rates only, you can use the domain tabs along the top of the dashboard (2).


This will display the numbers of patients with PCAs applied for each QOF indicator.




Viewing the Reports

To further display details of the reports, click on the View button to the right of the report name. 


This will allow you to visualise any trends in demographic details. You can view the list of patients by clicking on the PATIENTS tab, you may wish to review each patient’s record to investigate the reason for the PCA being applied.


Best practice suggests reviewing patients who are ‘exception reported’ from a clinical safety perspective to identify those who may benefit from further efforts to encourage engagement with reviews, ensuring they receive the necessary care.



Note - the patient details displayed above are fictitious data.


 If you require any further assistance on the process above, please contact the Ardens Manager Support Team on: support-manager@ardens.org.uk