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At the heart of general practice since 1960

‘We’ve had patients here for years who have suddenly been removed’

Dr Coral Jones on the damaging effects of list-cleansing

We are conscientious about cleaning up our lists. And yet several patients have been removed who have been here a long time. We don’t know how it happened. They don’t know how it happened. We have to go through a lot of work to get them back on the list again.

Patients are really upset. They come in and we say: ‘But you’ve moved.’ And they say: ‘We haven’t, what’s this all about?’.

In theory, patients might miss out on care they need. We have a high list turnover so we only get alerted to the problem when someone comes in wanting an appointment.

If people don’t come in, we would not know they are not registered. They might miss out on a screening invitation – anything could happen.

It’s not got any better under NHS England. In terms of all the problems with payments to practices, this is just another thing on top. It is more work for us to do to maintain our list.

It does seem to affect patients randomly, but it is the patients who have been here for longer who are affected. People get upset, quite rightly – they think we have taken them off. We’ve had people who have been here for years and have suddenly been removed. It is probably easy for NHS England to target somewhere like this, where there is a higher list turnover.

In Hackney, the list turnover is 25% to 30%. This is part of the reason, along with deprivation and the need for translation services, that we need extra payments in east London – it is a huge amount of extra work, chasing round other practices, having to be summarised, having to be put on the system.

Dr Coral Jones is a GP in Tower Hamlets, east London

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Readers' comments (7)

  • More reason than ever to move from a list size base to an appointment based payment system. The list size just increases our workload year on year.

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  • Surely this ghost patient regime needs to be applied differently in different parts of the country, especially urban versus rural. It would be obvious (I trust!) to safely assume that there has been more (latent?) "abuse" by high density urban practices with a high proportion of immigrants with a higher-than-average turnover of patients. These practices would find it more resource intensive to accurately monitor absent vs "present" patients, so that is where the focus needs to be to get more accurate payments adjusted. And it is up to the practice to maintain accurate records, and minimise patient dissatisfaction with re-registration, if it wants to provide good services to its patients - AND be as profitable as they can be (as a privately held company, which they virtually all are, whether corporately held, or by the partners). Like any company, practices need to know their customers (oops, sorry, "patients").

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  • LIST CLEANSING:
    List Cleansing is one of the last resort the Government is adopting to continue with the 'NHS which is free to all residents, non-residents or visitors.
    The methodology adopted in 'List Cleansing' is not only un-ethical but also reflect desperation for saving money. Patients are removed from GP's list but a new GP is not allocated, so NHS has not to pay any NHS contribution for such patients unless they go to their GP to find they are not on the list and fill a new form to re-join the same practice. In this process the NHS has saved money for so many months when the patients did not need a GP nor they were listed under any practice. What a shame!

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  • They [ the DOH] can do anything they wish. We are a powerless, weak, hopeless lot. No wonder no one wishes to join and everyone wishes to leave. The sooner this crazy system of MPIG, seniority,pensions, imposed contracts, les, des, cqc,list cleansing, disappears, the better for all.

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  • While MPs give themselves 9% pay rises.

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  • write to your MP. Write to the chair of the Health Select Committee. MPs love to receive letters from their constituents - they may know what the problem is, but they have to be able to prove that the public mandate them to solve the problem.
    I would suggest that every eligible resident in UK should be registered somewhere, and an exceptional few should be registered in more than one place. Therefore if someone turns up on another list, it's legitimate to cleanse them from the previous list unless they are flagged as multi-registered. If they die or move abroad, it's legitimate to cleanse them. But i can't see how it's legitimate to remove someone for no reason

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  • Case history
    Not sure if its list cleansing as she was a regular attender but a 90 yr old I know received a letter from her GP saying she should register with another practise. She had been with him since 1959!
    But sadly her mind is not as good as it was , she has no living family, has had many falls and paramedics have been called. She probably ranks as a 'nuisance' now. Sad . Thats what you have to look forward to when you are 90.

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