A quick guide to the NDRI
Andy McKeon, managing director of health at the Audit Commission, explains what the National Duplicate Registration Initiative means for GPs and list-cleansing
In late February, the Audit Commission published the results of the National Duplicate Registration Initiative (NDRI) 2009/10. NDRI helps identify ‘ghost patients' that skew the patient lists of GPs, and in many cases prevent the fair allocation of funding.
Despite what you might have read in some of the media coverage at the time, we are not suggesting that this is the responsibility of GPs alone. The problem can only be tackled with the combined effort of all involved.
Handling patient records is a major task. At any one time there are somewhere in the region of 58 million patient records in the system, and keeping them up to date is a big ask. On the whole, the NHS and GPs do this well, and the duplicate records, and other anomalies our exercise identified, represent a tiny number of the total number of patients in England and Wales – just 0.16 per cent in fact.
Why use the NDRI?
At a time when GPs, and all their colleagues in the NHS, have huge demands on their time and resources, data cleansing may not be a top priority. But it is certainly worth the time and effort, not least because it can deliver savings without having a negative impact on patients. In fact, it can bring benefits for patients and GPs, by ensuring that the right patient records reside with the current GP. And the savings are substantial.
NDRI 2009/10 resulted in 95,000 patient records being removed, saving the NHS £6.1 million in one year. Given the current economic climate, and the pressure on the whole of the NHS to cut costs, this is an important saving.
Better data - and better funding
Keeping lists up to date also helps to ensure funding is fair, particularly when the allocations for the proposed Clinical Commissioning Groups will be based on GP lists.
The NDRI is about data quality, not fraud. Indeed, there have been no cases of fraud identified through the NDRI. The NDRI helps to identify anomalies on GPs' patient lists – it compares a GP's list with other GP lists and with lists of people who have died or have left the country to identify ‘matches'. Those matches can then be investigated locally by the National Health Applications and Infrastructure Services (NHAIS) sites that hold the data on behalf of Primary Care Trusts (PCTs), and anyone who shouldn't be on the list can be removed.
Every removal saves the NHS £64.59, the amount GPs are paid for each patient on their lists. Unfortunately, in the 2009/10 exercise, not every area followed up the matches, which means there is still some work to be done.
In an ideal world, of course, NDRI would not be necessary because lists would be updated as patients moved or died. But many areas of the UK have transient populations, who do not always think to call their GP and inform them that they are moving.
And inevitably there are some errors. Whilst we believe the government should strengthen patient registration procedures, this will only help with some duplicate records – not with people who remain on records after they have died or left the country.
How the NDRI helps GPs
GPs can play an important role in keeping patient records as up to date as possible, using the NDRI.
For example, in Devon, the NHAIS site wrote to all GP practices asking them to confirm whether patients registered with them who were over the age of 100 were alive. As a result of the practices' responses, 135 patients were identified as having died or moved away, and were removed from GPs' lists. Similarly we estimate that Hillingdon removed 650 patient records thanks to the involvement of GPs in their data-checking exercise.
Our national report identifies other examples of good practice and what can be done further to improve the quality of the data on GPs' lists. The report contains recommendations for PCTs, NHAIS, and the Department of Health.
I write quite often about data quality, and it's always tempting to apologise for talking about something so technical when there are other, bigger issues, around. But as NDRI has shown, getting patients' records in order saves the NHS money, improves the patient experience and helps make funding fair. I can't imagine there are many people who wouldn't support all three aims.