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GPs go forth

NHS to investigate GP ‘fraud’ in retaining ghost patients

The NHS anti-fraud body is to investigate general practice in a bid to crack down on apparently incorrectly claimed GP capitation fees.

NHS Counter Fraud Authority is prioritising work that will involve looking into so-called 'ghost patients' - people who may have died or moved away from the practice but still remain on the patient list - in a bid to challenge what it calls 'fraud' within general practice. 

But GP bodies have pointed out that ghosts patients are a result of records management issues, and have said that any 'insinuation' of fraud on the part of GPs is 'shocking'.

GPs have also pointed out that the current funding system for general practice accounts for practices having a number of ghost patients on their lists.

A document outlining NHS CFA's priority areas for action in 2019/20 revealed plans to tackle potential fraud in relation to GP capitation fees.

The document said: 'This priority area will focus on GP capitation fees. We will work with colleagues in NHS primary care to increase confidence in our assessment of the losses to fraud in this area and form a basis for fraud prevention activity.'

According to the BMA and RCGP, the authority will also investigate GPs who are claiming funding for non-existent patients.

Both organisations have expressed outrage at the NHS CFA's new focus on general practice and have strongly denied suggestions that GPs are 'complicit in defrauding the health service'.

RCGP chair Professor Helen Stokes-Lampard said: 'The insinuation that GPs – some of the most trusted professionals in society - are complicit in defrauding the health service is shocking and will be incredibly hurtful for hard-working GPs and their teams who are struggling to deliver care to more than a million patients a day across the country, with insufficient time, resources or workforce to do so.

'It is, of course, important to make sure that patient lists are kept as up-to-date as possible, so that resources are used where they are most needed – and our administrative staff already spend a lot of time processing patients' notes when we are informed that they have died, left the surgery or moved elsewhere.

'But so-called "ghost patients" are nothing sinister - they are the result of a records management issue, not a case of surgeries deliberately profiting by keeping patients on their lists when they shouldn’t be there.'

The responsibility to vet GP lists for patients who are registered but no longer attend the practice was part of Capita's original contract, when it took on primary care support services in 2015.

However, the exercise was put on hold amid the upheaval faced by practices in the wake of the outsourcing, which saw NHS England cut 40% from its budget to provide such services.

BMA GP Committee chair Dr Richard Vautrey said: 'Data checks on practice lists is currently the responsibility of Capita, which we know has overseen a litany of failures in its running of GP back office functions. Practices, as always when this has been carried out in the past, will be doing all they can to engage with this process.

'Anti-GP rhetoric that attempts to distract from the failure of Capita to undertake list revalidation properly only undermines the morale of hardworking practices.

'Any list revalidation exercise must be done responsibly, as there is a real risk that patients could be removed from lists for not receiving or responding to a letter.'

An NHS CFA spokesperson said: 'This is an area on which the NHS CFA has limited intelligence, hence the choice to focus some resource this year in filling the intelligence gap.

'The priority is to better understand the vulnerabilities there may be in GP capitation and propose how these can be addressed.'

They added: 'Previous data analytics work identified a discrepancy between the number of individuals registered as residing in England and the number registered at GP surgeries.

'Our priority this year will be to assess whether these discrepancies remain and if they do, conduct further analysis to establish their nature and whether part of this is due to fraudulent activity or not.

'This will complement the work currently being undertaken by NHS England by working collaboratively with them to target specific areas of loss. The precise nature of the work being done is being developed at present, and involves a number of stakeholders.'



Readers' comments (41)

  • There is no way of knowing if the patient is still there. They change tel. no. without telling you and move without telling you. We had list clean ups done wrongly and patients complain blaming us again or if they get removed wrongly and did not get their medication and all the issues it causes.
    The DWP continues to pay benefits to people who have moved back abroad. We have a broken system and yet they are trying to blame GPs again when it is not their fault.
    I can see GMC, police, CCG, CQC jumping on this if they find one patient that has moved without telling you. This really lowers morale even more. God help any new GPs that want to join us .

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  • They wont be dead as removal is automatic via death certification

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  • The only thing that could possibly be fruadulent is how such an inept organisation like Capita could be appointed and retained by NHSE.
    Who is taking the backhanders here I wonder?
    And more to the point who is sorting this out?

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  • @DrDr

    Only true if they died in the UK I presume

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  • Another great NHS initiative which creates new problems and anxieties at great expense while ignoring the real problems of the failing NHS

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  • Can we just make life easy? Abolish capitation payment and pay doctors per service as done in some other countries.

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  • Vinci Ho

    Too busy following up the ‘boiling’ situation in Hong Kong but the inspiration drawn is :
    ‘’Useless laws weaken the necessary laws.’’

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  • Re Mini-me | Locum GP12 Jun 2019 1:08pm

    Yes indeed. The capitation system is a scam (it costs five times as much for medical insurance for my dog as a GP gets gross after business expenses).

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  • Since the GP practice is responsible for providing care to all REGISTERED patients, to the best of our ability, they would be entitled to the capitation fee if the patient is REGISTERED, regardless if they respond to letters from Capita! Fraud would be if NHSE decidess to take away money in respect of patients whom GPs think are on their books.
    Getting the books wrong is fraud on the part of Capita, not GPs!

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  • Waste of public funds by NHS CFS. NHS would be better off improving data quality and NHS CFS should focus on drugs/prescriptions fraud and contracts fraud. In many inner cities with mobile and temporary population no GP can establish accurate record of registered population because patients do not communicate to their registered GPs.

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