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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)

  • If they are not happy change the patient system pay per activity that will rid us of this heinous fraud we are allegedly undertaking in vast amounts.Oh I thought not they are already getting an ridiculously good deal they just want to squeezes the pips harder.Anyone for the exit the next stop is RELP.

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  • How about they pay us for the 3000 of our 17,000 patients that are not even counted or remunerated - we cover them for free- thanks to Carr Hill formula impact?!

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  • NHSE will probably spend more money than they will recoup, but at least they won't have missed the opportunity to slur GPs.

    But Capita...

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  • Ok
    This is straightfoward intimidation.
    It's got nothing to do with making sure all is correct.
    It's saying..look out GPs coz we are watching you..and we WILL make examples of some of you.
    We need a manifesto to " take back control" !!..as the humanoid form of Kermit the Frog intoned from the Brexit Party hustings..
    1. Every single GP in the grand ole UK threatens to go on strike. And we mean it. F*** the RCGP and the BMA and the GMC. They are stool pigeon collaborators. We will do this if the demands below are not met within 96 hours:
    1. Abolition of appraisal and revalidation. CPD over three year cycle as per RACGP .
    2. GMC abolished. New body set up fit for purpose funded by government. They want the public protected..they can damn well pay for it.
    3. GPs have option to opt out of public system and become freestanding business.. true self employment. Opening hours and work patterns up to practice. Can be private, public or mixture.
    4. Fee for service. The harder you work, the more you get paid. End of story.
    5. Creation if in hours housecall/ emergency service. No housecalls for normal practice work.
    6. Deregulate lab/ radiology/ physio services. GPs can refer for any goddamn investigation they want. We are perfectly capable in case you've all forgotten..
    7. Abolish catchment area bull. Patients free to choose. Doctor free to tell them to go somewhere else without fear of retribution from Health Boards.
    8. Allow personal lists as a result of 7.
    9. Double the average doctor salary to equal contemporaries in Australia, Canada.

    Wake up and smell the effing roses you sleepy b******s !!




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  • Well I have to reply Angus, as you're only half right. The private sector is ANY entrepreneur/innovater that looks for profit. It is the fundamental building block of our society resulting from the freedoms that we hold so highly, and that our forebearers have sacrificed so much to achieve. You sit here enjoying the fruits of that (e.g. the computer that you're typing at), whilst bashing it? It is not the 'private sector's' fault, that the services the NHS pays for, is inadequate. It is the lack of competition, which is the only driver of quality and affordability. Competing for state funds, is not real competition, as 'it's always easier to spend someone else's money'. I'd say remove most of healthcare from the state's control, and most of government as well :) The fundamental principles are more or less the same in all sectors.

    Also, I sincerely hope you're not still in Labour's camp. Parasites? They want to tax you more, nationalise more, control everything (inc speech), does that make them bigger parasites?

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  • Forget list sizes. Forget ghosts and ghouls. Imagine blaming GPs of fraud when I have no idea whatsoever who is registered or not registered till they make appointments. How is this fraud. And if we cannot keep GPs and practices are closing in spite of all these extra ghosts, how is cleaning up lists and reducing pay even further going to help ?
    High time we moved to payments per appointments.

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  • If you have 5000 registered patients and Crapita say you have 4900 why don’t you just deregister 100 of your worst patients and tell them to f**k off and get a new GP

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  • I'll tell you what is fraudulant: Making you work without pay. Time limited QoF on cancer and depression and wasting time chasing people who are not at all interested or bothers to respond. Extra patients and in OOH no extra pay but tons of extra risk and stress. Attending useless meetings pretending to listen to GPs.
    Copernicus is right. Payment by service and time spent. Charge them like they go for a perm/haircut/when they call a plumber. Do it like other professionals, the dentists and lawyers.

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  • Sadly there are some Practices who make no attempt to keep their lists accurate, and some who have deliberately manipulated their list sizes to maximise income. Whilst the hostile rhetoric is unhelpful, there is a significant problem with a small number of (usually small) Practices deliberately inflating list sizes.

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  • Stelvio
    Big accusation-hope you have evidence for this.
    BTW could you let me know how I might go about "inflating" my list size???

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