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Concerns had been raised that some GPs would exclude large numbers of patients to make more money.

But this latest study, which analysed clinical data from 96 per cent of practices in England, found that from April 2005 to March 2006, the average GP exception reported just 5.3 per cent of patients.

This is lower than the rate seen in the first year of the contract.

Lead researcher Professor Martin Roland, director of the National Primary Care Research and Development Centre, said: 'Exception reporting is an important part of the quality framework because it avoids perverse incentives for GPs to give their patients inappropriate treatment.

'Our results suggest that most GPs have been responsible in their use of exception reporting, though a small number need their behaviour monitored by PCTs.'

sanjay.tanday@haymarket.com

NEJM 2008; 359: 274-84.

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