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Gold, incentives and meh

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)

  • You have a small Practice, preferably with a Practice Manager who is spouse of a Partner. Your population includes a high proportion of migrants from overseas. You register everyone as a new patient, rather than see as a temporary resident. You are deliberately lax in checking for proof of identity. Many of these people will never be seen again or ever register elsewhere. And you issue repeat prescriptions without being overly officious about seeing the patient. Et, voila. I have seen this done.

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  • NHS England is a infested with self interest, troughers and anti GP sentiment. We need root and branch reform and proper resourcing of primary care, and a lot of the NHS problems will improve.

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  • Just Your Average Joe

    Maybe if the Government bothered to have accurate immigration checks with passport check in/out of country - they might actually know the right number of people in the UK.

    No issue with freedom of movement - but anyone from EU coming should register as being UK resident and then get NHS and NI numbers etc. When they leave country they are checked out - if stay out for 1 yr then triggers deduction from the appropriate UK list.

    Ghosts are actually real people and patients who may choose not to fill in the census 10 years ago! Accuracy of the census is so poor that it doesn't trump a real person who did come and register.

    Capita have responsibility to switch registrations as people move and re-reg with new GPs.

    There is enough fraud by the DOH on GP lists with several thousand real patients not being counted through financial fraud by NHS saying they pay according to weighted lists anyway.

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  • David Banner

    The picture accompanying this article is remarkably similar the the My Iron Lung EP cover.
    Spooky.

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  • Agree with Mad john.... but it will never happen in the Uk I'm afraid as the government knows most GPs wouldn't follow through on the mass resignations needed to effect change!

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  • Mini me
    You are spot on
    Change contract to 100% IOS
    The NHS and others already have the ability to monitor all our activity and can identify outliers who may be gaming or fraudulent
    Pay a GP for every intervention from reading a letter actioning a blood results or work for consultants 111 nurses paramedics and patients themselves and you will see morale amongst the majority of non cardigan wearing GPS improve overnight
    Or of course a salaried service clock on and clock off(when you have a cold feel stressed bullied etc etc)
    The present system is failing GPs especially those of us who foolishly practise according to experience gut instinct and a belief in clinical skills not guidelines algorithms best practice risk aversion
    Ask our colleagues who have moved down under how much better their system is
    Ashok Rayani
    Foolishly came back from Oz in 1988 because at the time I was still influenced by RCGP Cardigan wearing trainers!!!
    I worry for the future of my younger colleagues as I am at that point that I can retire
    We have been sold out by our own predecessors some of whom will have had gongs high pensions or both

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  • ashok Rayani @6:43pm.
    I can understand the sadness at coming back to this mess.
    Actually, for me I am now all packed and set to leave for good. Went to do a short locum in Canada at insistence of a friend - I loved it, best time of my life & career! This is why I got my experience of fee-for-service. I am going and can't see myself coming back.

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  • @Mad John | Locum GP12 Jun 2019 8:39pm

    Welcome to Canada.....that's exactly what family practice is like. If you are keen to develop your practice you get proper structured training in anaesthesia, O&G, ER or enhanced surgical skills. Joy, excitement and fulfillment!

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  • Hi Mini-me, did you try Oz yet?
    Similar pay to Canada but the weathers better! :-)
    Where in Canada re you heading to?

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  • @Curious 3:16pm

    Thanks...had option of Oz but family felt too far. I am going to Alberta.

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