The freedom of GPs to 'exception report' patients may be undermining efforts to reduce health inequalities, experts have told the Commons health select committee.

The concern has been raised in submissions of evidence to the committee's inquiry into health inequalities. It follows HSJ's publication last week of the exception reporting rate for all 8,331 available GP practices in England.

When a patient is "excepted", the practice discounts that patient when measuring its achievement against the quality and outcomes framework, under which GPs are paid. Excepting patients helps practices boost framework scores, as fewer patients whose outcomes are poor are counted.

HSJ's data showed hundreds of practices had exception rates more than double or triple the national average. The head of primary care at one PCT said: "This is what all primary care trusts need to see, on a weblink publicised to all primary care trusts by the Information Centre, as soon as it is available."

In its submission to the committee, the NHS Confederation said the concept of exception reporting formed the "main risk" to the bid to reduce health inequalities. It added: "The management of exception reporting forms a key element of the PCT role in the monitoring of the framework."

The charity Diabetes UK said it was concerned about what happened to diabetic patients who were exception reported. HSJ's analysis last week showed that the exception rate for diabetic patients was 6.5 per cent, but 360 practices had rates that were at least twice as high as this.