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Tens of thousands of 'ghost patients' wrongly removed from practice lists, GPs estimate

Thousands of people in the UK may have been wrongly identified as ‘ghost patients’ and removed from their GP practice lists in just one year, a Pulse investigation has discovered.

A Pulse survey found that 153 of 527 GPs (29%) said patients on their practice list had been erroneously removed through list cleansing during the previous 12 months, and the total estimate of patient numbers was about 6,700. Extrapolated across the whole of the UK’s 10,100 practices, the figure rises to about 130,000 patients.

Some GPs surveyed said that several hundred patients’ names were removed from their practice lists in the 12-month period, while one gave a figure of 1,000. Another GP reported that one three year-old boy had been removed for not returning an enquiry letter.

Survey respondents and GP leaders said the list cleansing mistakes variously resulted in patients directing anger at GPs, a reduction in earnings, and a weekend of extra work for a GP in gathering evidence to show that patients should be reinstated.

Pulse reported last year that around 25,000 patients had been wrongly being kicked off practice lists. However, despite the reforms to the NHS, the numbers seem to have increased since.

The NHS England London local area team had targeted 700,000 so-called ‘ghost patients’, sending letters to patients who had not been in contact with their practice in 15 months.

Dr Adedayo Adedeji, a GP in Dagenham, said more than 1,000 were wrongly removed from his practice list.

Dr Jacqueline Marshall, a GP in Uxbridge, Middlesex, said: ‘I’ve had to spend weekends in the practice obtaining evidence to prevent patients being removed erroneously. The list included the most vulnerable, for example older people, people with dementia, and mental health patients who did not reply to letters.’

However, GPs from outside London also reported having patients removed.

Dr Sanjeev Juneja, a GP from Rochester in Kent, said a three year-old child was taken off hers. She added: ‘We kept him on the books, as the family was still not excluded. The exclusion was due to the three year-old not returning a letter sent by the Kent Primary Care Agency.’

Some patients are unable to reply to letters because English is not their first language, she added.

Dr Shalini Gadiyar, a GP in Rochdale, said removals can result in anger directed by patients towards GPs.

GPC negotiator Dr Dean Marshall said: ‘Patients can get very agitated when they are wrongly removed, because they have no idea why it has happened. It can also cause an administrative burden for the practice.’

NHS England head of primary care commissioning Dr David Geddes said that list cleansing is necessary because there is a ‘significant financial burden on NHS resources if patient lists are overstated.’ He added: ‘Maintaining accurate lists is crucial because commissioners need to have an accurate knowledge of the populations for which they have responsibility.’

‘This enables them to plan accordingly. It is an on-going process which avoids the build-up of ghost patients, which artificially inflates the size of patient lists. It is very important to ensure that patient lists are accurate because NHS England is shifting to funding medical services contracts through a global sum payment that pays on a per patient basis.’

‘NHS England has explored good practice regarding list cleansing and will publish the results in a new NHS England policy document next month called “Tackling list inflation for primary medical services”.’

Area teams will work with GPs to investigate the effectiveness of this policy over the next 12 months, Dr Geddes added.

Readers' comments (8)

  • How about an apology, instead of an irrelevant explanation, from Dr Geddes about the extra work (and money) they have cost practices?

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  • IIRC the original GMS contract included a 4-7% reduction to allow for the existence of 'ghost patients'.

    Will 'clean' practices get this extra amount paid?

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  • If we get off people like Dr Geddes off the administrative list (oh I forgot he is the goverments right hand tail), a lot of NHS and GP resources will be saved.

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  • We had a family of many -single mum with several children removed from list as "too many in same house" flags up as possible ghost patients. Unfortunately all of them had been under child protection at some point or other. When we informed them that the deduction was not correct , we were ignored and they were deducted anyway. Due to child protection issues we didn`t want them to be without GP hence registered them as temporary patients and continued seeing them.
    After LMC was informed the PCT just said they were following centrally dictated procedures and refused to answer whose responsibility it would be if the children came to harm.
    I agree lists have to be accurate but rather than these draconian method, it would be easier to pay for each transaction (HRG tarrif) than capitation as that would eliminate this problem (will bring different set of problems though).
    This is in midlands with little migrant population.

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  • Why arent GPs invoicing NHS England for the work re-registering these patients and collectively taking them to small claims court if they fail to pay.

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  • Surely the answer is either to re-register them or to refuse to see them - after all NHSE has decided they are not your patients and give them the number of the LAT to sort it out.

    Unfortunatley continuing to see them because of 1 problem or another may be altruistic but in this day and age we cant afford to pay the NHS for others healthcare.

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  • if you can't even take a stand over this we really deserve everything that gets thrown at us. If we're so pathetic that we see patients as temporary patients so it makes us feel a little better, then those who would had actual responsibility will continue to feel free to trample on us.

    We really are our own worst enemies

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  • The number of patients in our practice who go off to university and register there, but as they spend almost half the year on holiday, and come back to see us for all their care even though they are no longer registered, as it is convenient.

    We end up providing all their care but with no payment. I would like to see payment for these 'Ghost' patients given to us in a positive way.

    Just because there are patients who had not been in contact with their practice in 15 months.ie most fit and well people, doesn't mean they don't exist.

    It is exactly these patients whose funding is there in case, but usually subsidises the care of the chronic sick. If you remove them as ghosts, you just end up with an under funded service, bursting at the seams, as there is not enough funding for appointments for the young, old and the chronic sick - without the balance.

    This is just another stealth tax on Primary Care.

    BMA why do you allow them to get away with this policy which harms those most likely to be in need - the old, the sick, those with dementia or learning difficulties, mental health problems and those who don't have English as a first language.

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