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Patients who haven't seen GP in five years could be booted off practice lists

Exclusive Practices will be told to identify patients who have not visited them in five years under plans being developed by an NHS England local area team that could see numbers of patients being left without a GP. 

The NHS England East of England regional team has told Pulse that it is considering implementing a policy that would see these patients contacted and, if they don't respond to two letters, they will be chucked off their practice list.

It told the LMC that these patients may be in 'incredibly good health' or may no longer require services.

But GP leaders has said they have raised concerns about this approach in discussions, warning that this could disproportionately affect certain groups, such as adolescents and men aged between 20 and 45, and create extra workload through enquiries. 

The local area team said it will commission support service providers to write to patients as part of its list-cleansing process and it is currently in talks with the LMCs in the region to finalise this approach.

It claims that practices 'should not experience any increase in their work', as they will not need to send the letters out themselves.

But it admits that practices will see an increase in patients contacting them for clarification, and GP leaders said there would be workload burdens. 

The area team sent a letter to LMCs in the region about the policy, stating that people who had not seen their GP for five years 'may be the people who no longer require services’ and may be in ‘incredibly good health’.

It added that list validation is necessary ‘to protect NHS money and ensure patient lists are not artificially inflated.’

Pulse has already revealed how managers’ overzealous list cleansing drives in recent years have led to tens of thousands of genuine patients being removed, even after practices have flagged the mistakes.

But the latest measure would expand this even further with continued registration contingent on patients reading and responding to a letter from their GP, and potentially needing to reregister.

Cambridgeshire LMCs has said they had collected data that show some groups, particularly children in early adolescence and men aged 20 to 45 could be disproportionately affected.

In a letter to practices, Cambridgeshire LMCs said: ‘NHS England now wishes to add to practices burdens by demanding you identify all patients on your list who you have not seen for five years, as they believe “it is reasonable to deduce that this group may be the people who no longer require services”.

‘Their letter says people who haven’t seen a GP for five years may be in “incredibly good health”, and would then be able to return a letter to the GP to confirm they wish to remain registered.’

It added that the LMC was ‘very concerned about this - on grounds of discrimination, on grounds of workload, on grounds of making care for children and middle aged men less accessible.’

The LMC added: ‘We note the true motive for this proposal from NHSE is, as they say, “to protect NHS money and ensure patient lists are not artificially inflated”.’

Cambridgeshire LMCs chief executive Dr Guy Watkins told Pulse: ‘There are two peaks where it would apply, men between 20 and 45, and the other peak that’s very interesting is children. A large cohort of children between about eight and fifteen.

‘And that’s clearly a safeguarding issue, because they’re post routinely being seen, post most childhood illnesses, but actually they’re not being routinely brought by their parents.’

Andrea Patman, head of commissioning for NHS England (East) said that the 2013 policy to tackle list inflation recommends targeting patients who have not accessed general practice for five years or more.

She added: ‘Practices should not experience any increase in their work as [primary care contract services] will undertake this process on behalf of NHS England but, there may be a slight increase in patients contacting their practice for clarification of their action required.

‘NHS England would like to clarify this exercise should not result in decreased access for moderately hard to reach groups.’

The 'ghost patients'

The NHS has been carrying out list-cleansing drives in recent years that have led to tens of thousands of genuine patients - so-called 'ghost patients' - being removed.

There removals have persisted even where practices had already flagged patients as ‘validated’, leaving them out of pocket for the time sent identifying mistakes and causing distress to patients.

The FP69 list validation process already requires validation of patients from overseas, one year after they register with a GP, students after three years – regardless of course length - and centenarians.

GP leaders have said that identifying these groups to verify their residency - with the exception of centenarians who tend to be in regular contact with practices - already presents a significant burden.

Read more about 'ghost patients' here

Readers' comments (82)

  • Nhsfatcat

    That's fine.
    As we are only paid for 2/3 consultations a year, can we charge NHS to pay for the other 3 apparitions that occur per patient per year?

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  • Will they pay more for patients who attend the 2.4 times a year which was the average when GMS contract was signed?

    Can we have a PBR tariff per consultation over the 2.4 times or start charging for extra appointments.

    "SEEN A GP" -Do telephone, Video (Skype), e-consults count as consultations?

    If not why not?

    Jeremy Hunt wants at least 15% to use apps to consult doctor by 2017 -will those be removed from list they haven`t "seen" their GP for a specified time?
    I haven`t seen my GP for 9 years BTW so I am a "ghost patient" as per NHS England rules and thereby can I avoid paying tax and NI please!

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  • in 1990s,HA said patients removed had been sent registered letters returned as "not known at this address" - but could never produce them when asked.
    The next step was to refuse to allow re-registration at the same address - because the supposed registered letter had supposedly been returned - "proving" not only that the patient (if existed) didn't live there, but also grounds for suspecting fraud on the part of the practice...

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  • So let me see if I have got this right.....
    All those who are responsible and eat well and make an effort to look afterthemselves are to be rewarded by being excluded from having free medical care and kicked off the gps books.
    Yet all those who do not look after themselves and drink and eat too much of the wrong foods etc...will get rewarded by getting free continued health care!
    Jeremys idea of fairness

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  • You couldn't make it up!Kafka: now is thine hour!Do we have a national Health service,in which case it is reasonable to assume, as all studies show, that people do not see their GP, because they are perfectly well.
    ..or do we have a national Illness service which creates a dependency culture.
    To be ever so slightly controversial, if we study the population who do actually see their GPs, we find that the overwhelming majority of these are also,despite their protestions, perfectly well.
    If NHSE removed these people, and we were left with the genuinely well (whom we don't see) and the genuinely ill (who we should be concentrating on) workload/burnout/recruitment would be solved at a stroke, ......or am I missing the point?

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  • This has got to be one of the worst ideas I have yet heard in my professional life as a GP and Clinical Chair of a CCG.

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  • Under the Carr-Hill formula in 2004 a deduction was made for ghost patients - as I recall 10%. Since then we have had patients cleansed off lists and now this. Does this mean the 10% will be added back to compensate or has a change taken place that I missed somewhere along the line?

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  • We need to be aware that, at the point where primary care starts to collapse, patients who have been booted off their GPs' lists in the this way may find it incredibly difficult to reregister, thus doubly penalising them.

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  • So,if plans for prevention and enabling people to stay as healthy as possible actually work then we will reward those who look after themselves by removing their ability to see a GP if they do fall ill.
    You couldn't make up this kind of stupidity in the most ridiculous sitcom possible.
    Whats the point, lets all smoke,drink and eat crap, don't bother to work and some other sucker will pay for it all

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  • If they do it in a flexible way, and admit that it is a cost saving measure that will hit the pockets of GPs directly, and hence have measures in place to compensate them, fine. If not they can go jump.

    There is a limit to how far you can push general practice before it will genuinely fall over. I think the politicians think we are crying wolf, and I thought that myself for a while, but not any more. I'm making back up plans to earn a living elsewhere in case general practice implodes. Fingers crossed.

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