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At the heart of general practice since 1960

'We want our list to be accurate but caring for our patients must be our primary aim'

A practice manager in north London explains their experience of dealing with the fall-out from three list-cleansing drives in the last four years.

I work in a large practice in a leafy north London suburb. We serve more than 17,000 patients on one site, and our registered list has grown from 15,000 in the last three years.

The north-central London boroughs – Barnet, Camden, Enfield, Haringey and Islington – have seen their populations rise by 14.66%, according to the census figures released by the Office for National Statistics in July. 

Yet in spite of having just completed a validation exercise in 2011, we are poised to begin yet another round at the behest of our PCT.

Background

The first list-validation exercise we undertook back in 2008 was a huge and costly process for both the PCT and us. It started with individual letters to all patients from the trust, regardless of whether they had been in touch with the practice over the previous three years, asking them to confirm that they still lived at that address.

People didn't respond to the letters and the result was that we started to receive FP69 flags from the PCT in floods. Normal work for the registration officer was curtailed while we phoned, wrote and chased to keep patients on our list.

When the PCT wanted a re-run of the exercise in 2011, we were able to persuade them to take a more sensible approach by running a search first to identify patients who had been in touch with the practice in the previous three years so that they could be removed from the letters process. The level of FP69s was reduced to around 1,000 this time, and ultimately lost us just 300-400 patients.

Having completed that exercise, it was frustrating to be instructed by the PCT to complete a further exercise for this new financial year and to have the contact period dramatically shortened to 15 months, with those on disease registers excluded – although these are the most likely to have been seen in the practice, so it is an illusory concession.

In my experience, there has always been a discrepancy between the patient head count shown on our clinical systems and that provided by the PCT. We know our list has been growing consistently, and the census confirms our local population has grown by far larger numbers than the NHS in London had estimated. This time-consuming and costly list-cleansing exercise does not reflect the changing demographics and mobility of our patients.

Challenges

The three significant issues for us as a practice in having to carry out ever more draconian list-validation exercises are clear:

  1. An increase in workload – We want our list to be as accurate as possible, but caring for our patients should be the primary aim of every member of staff's working day. It is galling to spend so much time and energy justifying what we know is the reality – our list is growing, not decreasing.
  2. Cutting the no-contact period to 15 months– This dramatically increases the likely number of FP69s we'll receive. We have analysed our data and found cutting the no-contact period particularly affects men aged between 18 and 50 - those least likely to be in frequent touch with a practice unless they have a chronic disease, and also more likely to bin the PCT letter.
  3. Ignoring local population trends– The 15-month period for contact does nothing to reflect the fact that our population changes rapidly, as it does it many London boroughs, and the census figures now bear this out. List-validation processes should also to go hand in hand with clarifying who can register with a GP.

The author is a practice manager in north London

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