a medication is not clinically appropriate; patients not tolerating medication; patients refusing investigation or treatment (informed dissent); patients with supervening conditions; cases where diagnostic/secondary care service is unavailable. Practices in Scotland have been found to use exception reporting appropriately in that patients who were older or who had dementia were more likely to have been "exception reported". However, younger or more socio-economically deprived patients were more likely to be recorded as having refused to attend for review or not replying to letters asking for attendance at primary care clinics. It has therefore been highlighted that primary care practices should identify and monitor these individuals (i.e. the youngest and most deprived with cardiovascular disease) so that all patients fully benefit from the implementation of the new GMS contract and receive appropriate clinical care to prevent further disability and mortality. Advantages and disadvantages Assessments of its success are mixed. The new GP contract as a whole cost £1.76 billion more than the Government had expected, mainly because GPs had been expected to achieve 75% of the available points in the first year and actually achieved 90%. Tim Burr, head of the National Audit Office, said in 2008: "There is no doubt that a new contract was needed and there are now 4,000 more GPs than five years ago. But in return for higher pay, we have yet to see real increases in productivity." However, substantial improvements have been noted, particularly in the maintenance of disease registries and screening of risk factors for older patients with cardiovascular disease in the community. Ben Bradshaw, the Health Minister said: "The GP contract… has stemmed the haemorrhaging of GPs from the NHS and improved the quality of care for the public. Longer consultations, quicker appointments and being able to book ahead are improvements valued by patients." Laurence Buckman, chairman of the BMA's GP committee, said "The early evidence is that the contract is leading to improvements in clinical care". A 2016 study published in the Lancet assessed the effect of QOF on mortality. It found that the QOF had no effect on mortality. Data collection NHS Digital collects and publishes an annual report using QOF data. As this information is linked to funding GP Practices take a good deal of trouble over it and it enables direct comparisons between practices across England. Data about disease registers and achievement indicators have been collected at the end of