EDITOR—Kenny notes that 93% of general practices achieved the maximum points for diabetes care.1 A matter of concern is the apparently inconsistent manner in which the targets were reached.

Data in the public domain (www.ic.nhs.uk/services/qof/data/) show that some practices that achieved maximum points had excluded a sizeable proportion of their target population, using the exception reporting facility that allows individual patients to be declared unsuitable. The wide disparities in exception reporting between some neighbouring practices may sometimes have a valid explanation, but satisfaction with the quality and outcomes framework will hinge on clarification of what is acceptable and the adoption of uniform standards.

Options available to primary care trusts range from provision of supportive advice to the use of the post payment verification system. Unless this is done, a substantial number of patients may receive suboptimal care, and practices that have hit their targets without resorting to extensive exception reporting may become disillusioned.