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CAMHS won't see you now

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)

  • So if a patient is fit the GP is penalised?
    Surely this goes against the concept of a capitation fee based service?

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  • they should beef it up a little.Include all those who have not seen their GPs at least four times in the last month and we can really concentrate on the deserving.

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  • Surely telling anyone whether a patient has been seen or not without their consent is a breach of confidentiality whatever the time period. Let them send letters to evey patient every 5 years so that it is nondescriminatory! I guess they might decide the cost benefit balance goes the wrong way!

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  • 'Under the Carr-Hill formula in 2004 a deduction was made for ghost patients - as I recall 10%.'

    This is correct (although I thought it was 8%).

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  • Two points:
    Firstly, this must suggest that in the absence of consultations about the otherwise incredibly well people's quintennial stubborn strep throats, those showing up regularly enough to cling to their entitlement to primary care will be the elderly and the chronically ill. As these groups have complex problems and probably can't be shunted politely out with a pep talk and/or script, ten minutes is not likely to be a long enough appointment slot. Logic suggests 20 minutes at least.
    Secondly, does this mean the Pogrom victims' remaining paper notes can be bunged in landfill somewhere far away? What if they come back?

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  • Vinci Ho

    Some simple arithmetic:
    You want to save money by cutting this chunk of patients who have not seen GP last five years and labelling them as 'healthy'. Fine. The argument may stand if GPs were still in the 'old fashioned' era dealing with only coughs and cold ; vomiting and diarrhoea .If chronic disease management is the main activity these days , taking a big chunk of so called 'healthy' patients away from the list will suddenly increase the prevalence of these chronic diseases:diabetes , COPD, asthma etc . So one can argue more money for suddenly risen prevalences in each practice !!!!

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  • Holy Crap!! They really are _ucked up in their heads!!

    If they really want to tackle excess workload and have some balls, then why don't they make patients pay just £10 per consultation.

    All the punters who abuse the system for minor cough and colds would suddenly wisen up!!

    Ah !! but that is politically sensitive and might cost them the elections!!

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  • Average consultation rate in NI approaches 7 for 60 pound profit per year. Factor in 40% paperwork and profit per consult is 36/7. Give back to the DOH tax and NI and you take home 2.80 per consult.
    And they want to now remove the patients who do not see us so average will be say 8 consults per patient.
    And the GPC still thinks this Contract is a good idea.
    Consider profit in NI was 80 for 4 consults in 2005.
    We have 55% reduction in profit per consult and so by extension per item in 10 years.
    I suppose there will always be the altruistic types like our leaders who will be GPs. Good luck to GP land. If there are mugs to work for this kind of money, good luck and good fortune.

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  • Thinking back to when we used to use paper notes I learnt quickly as a registrar that the (usually a) man coming down the corridor for the first time in 10-20 years with an unusually narrow set of notes usually had a very good reason for attending.
    Creating barriers to make it harder for these people to attend could be harmful.

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  • IF every one on list see a doctor, general practice would be totally unviable. we see same same people repeatedly. healthy are the who subside the service by not using. you can't have a cake and eat it. if you don't want to pay for those who do not see us then pay per visit fot those who do. i think we will be better off. charge £60 per consultation and item of service fee and DES LES.

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