Primary care trusts must ensure they have a strategy in place on GP exception reporting, a health inequalities official has warned.

Speaking at a King's Fund conference last week, Professor Chris Bentley, delivery manager at the Department of Health's health inequalities national support team, warned that PCTs must ensure their policy was clear where GPs were exempting a proportion of vulnerable patients from their statistics under the quality and outcomes framework.

His comments follow an HSJ investigation revealing the scale of exception reporting.

Mr Bentley cited patients with chronic lung disease being exempted because they were housebound.

"Why should you exempt the most complex and vulnerable?" he asked.

A DH spokesman said PCTs could agree tailored framework targets with practices on local contracts. They could also develop local quality incentive schemes with GPs on the national contract.

But a senior source thought it "very unlikely" PCTs would be allocated funds from the outcomes framework to set their own targets.

He said: "I suspect there was a fear that PCTs and local practices might come to rather cosy arrangements."