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A faulty production line

Practice list cleansing should be stepped up 'immediately', say influential MPs

NHS England must step up its drive to remove ‘ghost patients’ from practice lists as inaccuracies could be having a knock-on impact on CCG funding allocations, an influential committee of MPs has said today.

In a report by the Commons Public Accounts Committee (PAC), MPs found a huge disparity in CCG funding allocations, and put part of this down to the fact they rely on practice lists as a measure of population size, which they claim contain a number of inaccuracies.

The committee concluded that NHS England should take ‘immediate action’ to ensure area teams are validating practice lists.

Pulse revealed in September that thousands of patients had been wrongly removed from GP lists and forced to reregister as overzealous area teams tried to cut costs.

But the PAC says that NHS England should ensure local area teams comply with its guidelines designed to increase the number of reviews of patient lists.

The report recommends: ‘NHS England should take immediate action to ensure that all area teams are complying with its guidance on GP list validation, at the same as taking forward its longer-term plans to gain greater assurance over the data.

‘[Despite improvements] GP list numbers still tend to be inflated as people may remain on lists after they have moved out of an area. This is a particular issue in areas with more transient populations.’

‘At the same time, GP lists do not include unregistered patients which may affect areas with high levels of inward migration. Most of NHS England’s area teams have done some work to validate GP lists, but NHS England accepts that it needs to do more.’

They also called for NHS England to address the plummeting proportion of funding which is devoted to primary care, and to overhaul the primary care funding allocation formula, this time with greater input from advisory bodies.

Last year NHS England announced a redesign of CCG funding formula to take better account of deprivation, and now the committee is urging them to do the same for the primary care formula before the 2016-17 round of funding allocation.

The report states that two fifths of CCGs are still more than 5% above or below the target funding allocations, with variation from £137 per person below target, up to £361 per person above target.

It said this ‘has important implications for the financial sustainability of the health service’, as 19 of the 20 CCGs predicted to end the year in, or close to, deficit were being underfunded.

Dr Richard Vautrey, deputy chair of the GPC, said: ‘Variation in local funding is a longstanding problem which has not been addressed for many years. While the pace of funding improvements for CCGs has been very slow, general practice has been subjected to very rapid and unreasonable funding changes which are having a major impact on some GP practices, especially in rural areas and some areas of significant deprivation, as they lose much needed investment.’

PAC chair Margaret Hodge MP said: ‘At the current rate, it would take around 80 years for all local health commissioners to reach their target allocation.’


Readers' comments (9)

  • I have a simple solution - do away with Global Sum and MPIG altogether and pay us for activity. Immediately that gets rid of the alleged ghost patient problem, and practices egt increasing payment for the increasing amount of work done instead of a fixed payment for an ever expanding workload - it's how every business on the planet works and how NHS Hospitals get funded, why is general practice stuck with this awful "fixed fee for unlimited work" funding model?

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  • I agree with practice manager above. Like in australia and the private sector, pay a fixed rate for in hours care, and extra for evening and weekend opening.Much more for home visits (£100 per visit). It will encourage more appointments than the current scenario, and the ones who are really keen to open all hours of the day and night will be handsomely and appropriately remunerated.

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  • MPs Committe should also get rid of the formula and consider payments for all registered patients in the Practice. You can't continue to reduce a Praqctice's list for payment purposes by 500 patients (almost 12.5% if you have a list size of 4000) and demand work to be done at the same level as a Practice with 2600 but list updated and payments made for 4000 due to abnormal weightage increase in list size.
    These disparities need to go - it is a sick practice.
    And once these are gone - you might want to liquidate the PCAs and NHSE and invest the billions saved in inflated salaries into Primary Care services.

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  • Sanjeev Juneja - Be careful what you wish for. All English PCAs (Primary Care Support Services) are about to be sold off to the highest bidder. Inflated salaries? Hardly. Most staff at PCSS organisations are band 2 and that is only just above the living wage.

    Seeing as it is the PCSS organisations that would carry out the list cleansing for NHS England, I wouldn't expect much to happen whilst they're all under the cosh. Good luck dealing with their private replacement though.

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  • 10:49: If privatization is an inevtiability, and we know it is, let's just have it.
    I think most of us would want an open and frank approach and it would be appreciated instead of beating around the bush.

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  • payment by each patient activity is the way forward. its for government to decide who pays for it ,tax payers or individual patients .
    BMA GPC should start negotiations for this new contract.

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  • Average list size has to go. The main complaint from patients,papers, politicians is that we do not provide enough appointments and therefore the ills of the NHS like A+E delays is due to the GPs.
    In spite of dealing with 92% of all face to face consultations in General practice on 8% of the budget; in spite of working 13-14 hour days, as Michael Dixon points out, we never do enough; in spite of doubled consultation rates for less money in the last 10 years, we do not do enough.
    So, it is time to define enough in work outputs and work done as ALL contractors in the planet do. Since the main bugbear is appointments, let us have a system wherein the DOH buys so many appointments from a full time GP pro rata, at 15 minute per appointment. Once we provide that if patients do not get appointments, the DOH will have to pay more. This is simplifying a complex issue, but list sizes designed, no doubt, by the Colossus in Bletchley in 1948 at 1700 is out of date long ago, and now equates to 17000.
    Average list size suits the DOH because all workload can be offloaded on its coat tails and they do.
    I proposed this at the LMC last year in a motion and was not carried.
    I feel personally that as long as average list size remains, with ever increasing workloads due to increasing average Consultation rates, that General Practice will slowly die because there are no definitions of safety for the GPs, and very few would wish to join or stay in an uncontrollable workload.

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  • Circle has pulled out of Hinchingbrooke, citing a 10% cut in pay.
    We GPs, have a 25% cut in pay and a 50% increase in workload in 10 years.
    We should exactly as Circle. GPC, it is time to leave the NHS. Please ballot. Any sensible Private Contractor would do the same.

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  • Agree...we need a ballot on mass resignation from the NHS. How much more are we expected to take? GPC are you listening?

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