HSJ has highlighted widespread variation in exception reporting rates. These certainly need to be investigated by primary care trusts, writes Martin Roland

However, this should not become part of a wider campaign to eliminate exception reporting (which averages only 5 per cent). Exception reporting is a key part of keeping the framework indicators safe. In developing the indicators, a decision has been made by government and the British Medical Association to have no upper-age cut-offs. This is despite the fact that there is little evidence for many of the interventions in the care of the very elderly, so they are not evidence based in this group.

Clinical guidelines have never been intended to apply to 100 per cent of patients with a condition, and it is critical that GPs retain the ability to exclude patients for whom they judge treatments are clinically inappropriate.

Professor Martin Roland, director, National Primary Care Research and Development Centre