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GPs told to identify ghost patients every year in 'disgraceful' list cleansing drive

Exclusive GPs will be expected to provide primary care support provider Capita with a list of suspected ghost patients every year under the biggest ever list cleansing drive that could increase practices' workload burdens and result in them losing funding, Pulse has learned.

Under the terms of Capita's contract with NHS England, obtained by Pulse, the outsourcing giant will contact practices every year demanding a list of all patients who have not had contact with the practice in the previous five years. 

NHS England has told Pulse it would consider changing the GP contract to ensure practices provide these lists if it became necessary, saying that list cleansing initiatives were important for maintaining the efficacy of screening programmes, performance assessment and ensuring public funds were used appropriately.

But GP leaders said the scheme was 'disgraceful', and will lead to extra work for practices and an unfair reduction in funding.

Pulse has also reported that previous list cleansing drives have resulted in thousands of genuine patients being removed.

The Capita contract performance standards state: 'The supplier shall contact all GP practices in the eleventh month of every contract year requesting a list of all patients who are recorded as not having had contact with the GP practice in the past five years.’

Upon obtaining the list, Capita will contact each patient 'within ten working days' to confirm their 'current address and registration details' or launch a process to scrub them off the list.

Under the scheme, any patients identified will be sent two letters by Primary Care Support England - the arm of Capita set up to provide support to practices - and if no response was received, an 'FP69 flag’ would be set on the GP practice system.

This gives the practice six months to establish contact with the patient to confirm their registration or else they will be de-registered.

Annual list cleansing drives have formed part of NHS England national policy since 2013, but Pulse understands it has only actually been implemented consistently in parts of London, while practices elsewhere may have never received a request.

But when NHS England (East) proposed to enforce a similar process earlier this year, LMC leaders raised concerns that it could make care less accessible for children and middle aged men.

Despite these concerns, NHS England is pushing ahead with rolling the scheme out across England.

A spokesperson told Pulse: 'PCSE supports the maintenance of GP lists by undertaking a number of activities, including writing to patients who have not contacted their registered practice within five years, as this could be an indicator that the patient has moved away.

‘The National Audit Office and House of Commons Public Accounts Committee have all drawn attention to the need to ensure accurate patient lists, and for proper stewardship of public funds.'

They added: 'We doubt that contractual change would be needed but, should it be, we will cross that bridge when we come to it.'

But Dr Tony Grewal, medical secretary of Londonwide LMCs, told Pulse they had actively challenged the list cleansing of patients not seen for five years or more when it had first entered NHS England policy.

He added: ‘While maintaining a clean list is to everybody’s benefit, these massive initiatives produce lots of extra work for practices; it produces risk to small numbers of patients and inconvenience to large numbers of them.'

The schemes also lead to practices missing out on funding due the capitation system. 

Dr Grewal said: ‘It’s disgraceful behaviour in this time of extreme pressure and completely goes against the principles of the GP Forward View and the acknowledgement that general practice needs support at this stage and not further onerous burdens which are simply there to take money away from practices.

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, said differences in attendance rates already accounted for in the general practice funding formula and this exercise will cause 'disruption for patients' and loss of funding 'disproportionately impacting vulnerable practices.'

He told Pulse: 'Patients have a right to be registered unless they move or register elsewhere, even if they don’t need to or choose not to access services. So running a fishing exercise using this arbitrary time limit is wholly unacceptable.

‘NHS England can only obtain this information by requesting it from practices; passing this on would breach patient confidentiality and so it cannot possibly be considered reasonable; it is not therefore a requirement under the regulations and any change to the contractual regulations, which NHS England is implying might happen, is as a result of negotiation between DH and the GPC and not a matter for NHS England to determine.'

Capita confirmed it was aware of its contractual standards but declined to comment further.

Neither Capita nor NHS England could say when the first national request for ghost patient lists would be made.

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 (97)

  • Paul Cundy, PLEASE, instead of wasting your time on making a personal assault on us, DO briefly explain to me why my indignant comments against arrogant 'poor me' members' comments are wrong

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  • I think the point is that the per capita payment calculation results in payment which is not enough for the GP service at the moment whatever the rights and wrongs of it. Clearly we would wish for an accurate patient list but if this leads to a loss of income then it is an issue and there is also the potential work involved in reconciling the list. The system is not a payment for work done but involves a calculation of averages hence the outrage expressed above.

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  • @Anonymous GP partner 4.21pm 20 Jul

    If you have a non-registered patient calling on you for treatment, cannot you sign them up as a temporary resident?

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  • We all write to/text/call our patients recalling them for health promotion and also clinical reviews. If they do not respond we do not know whether that is because they have moved away or because they cannot be bothered to come to the GP. So are they a ghost or not? This is the point we are trying to make. Just because they do not attend the surgery, or contact us, doesn't mean they are not still a valid (healthy) patient. This proposal means anyone who doesn't reply to a bureaucratic letter will be regarded as a ghost - and we then have to spend many hours chasing them down to prove they are not. This costs us staff time and also annoys the patients.
    Or are you suggesting healthy people who do not need medication shouldn't be registered with a GP?

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  • If no contact either direction ..GP to patient or patient to GP then as a matter of probity.. Yes they should be removed.. whens the last time most gp's actually went to their own gp ... Cant remember the last time my own gp practice bothered to get me in?

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  • If no contact either direction ..GP to patient or patient to GP then as a matter of probity.. Yes they should be removed.. whens the last time most gp's actually went to their own gp ... Cant remember the last time my own gp practice bothered to get me in?

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  • Pharmacist@11.53
    Not unless patient only temporarily in the area with a home address elsewhere. If you are asking thinking we can claim payment for each TR seen - we can't. An estimated amount based on historical data is/was somewhere in the global sum and we can no longer claim according to work done.

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  • Our renumination is based on a pt seeing you 5-6 times a year and healthly pt- non attendant- balance the high demand pt. The aim to work harder for less award.

    Time to leave the NHS

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  • Is this policy discriminatory?
    Women have 5 yearly smear invitations /mammography screening etc, depending on age etc.
    What incentive for men of a certain age is there for going to the Dr?

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  • @ GP 1:47

    As i said on an earlier page almost all our patients who have had no contact in the last 5 years come in the lowest categories for weighting.

    81% are Male as women we get screening results for and they come to us for contraception.

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  • Anonymous | GP Partner|21 Jul 2016 12:34pm

    Pharmacist@11.53
    Not unless patient only temporarily in the area with a home address elsewhere. If you are asking thinking we can claim payment for each TR seen - we can't. An estimated amount based on historical data is/was somewhere in the global sum and we can no longer claim according to work done.


    OK-Thanks for the reply!

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  • IF YOU REMOVE PATIENT FROM GP'S LIST THEN TELL THEM NEVER TO CONTACT THAT PRACTICE FOR HELP. YOU DEPRIVED THEM OF MEEGER INCOME AND SHOULD NOT EXPECT PATIENT TO GET SERVICES AT TIME OF NEED FOR A TINY AMOUNT ,WHICH WILL BE CALCULATED AT END OF QUARTER.
    IF NHS PAYS A BIG FEE TO CONSULT A WRONGLY REMOVED PATIENT THEN IT MAY BE REASONABLE . FEE SHOULD ON EQUAL TO PRIVATE GP PER CONSULTATION

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  • I know nothing about the funding for pharmacy services and it is clear from here that pharmacists know little about funding in GP Primary Care. Perhaps pharmacy should think about what would happen if there was an obligation from patients to return unused medicines to the dispensing pharmacy, then the dispensing fee should be clawed back and if the pharmacist wished to dispute the appropriateness of this there would be innumerable administrative hoops to jump through. That would certainly affect profits and increase workload and affect the business model.

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  • Dear All,
    OK lets try and explain it for June and the pharmacists and other non GPs who plainly do not understand how general practice is funded. Since 1948 the majority of GP income has been based on capitation payments. A certain amount each year for each patient. The amount is fixed and independant of how often they come. From this income the practice has to provide services for those who do come. Ergo there is subsidisation, the money being paid for those patients who do not come is diverted to pay for the services for those ones who do. The patients who are using our services now gently age and die and are replaced by those that previously didn't come, because they were healthy but now have gently aged and have become consumers. They are now being subsidised by the younger next generation of non attenders and so the system rolls on. The concept that the GP is being paid for doing nothing for the non attenders is a fallacy. Since 1948 the amounts paid per patient have varied but that has basically been the system. Because the payments are for each patient and fixed each year removing the money for non attenders removes the money from the overall pot, it is not recycled. Therefore removing payments for non attending patients ONLY ever results in less money into the practice and NEVER results in less work for the practice, in fact the work goes up because we eventually end up re-registering 60-80% of the patients who were removed.
    Its difficult to make it any simpler than that.

    Oh and lastly to the person who extolled the virtues of "prevention". Wrong again. No degenerative disease can be prevented, arthritis, diabetes, hypertension, IHD, dementia, non of these diseases can be prevented, they can be deferred or delayed but there is no evidence anywhere on the planet in any health system that population wide prevention works. All you do is delay the onset and defer the costs. Another fallacy for these who never challenge anything.
    Regards
    Paul Cundy

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  • Patient-'Hello I want to see my GP please because I am very dirty'

    Receptionist'oh! You have been cleansed'Seek redemption in another 5 yrs during that time remain dirty'

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  • Paul Cundy, thank you for your comprehensive explanation which, incidentally, is how I already understood the situation despite all the confusing posts ! However, surely we are NOT talking about non-attending registered patients BUT registered patients who are no longer in the area, have moved on or have died !?
    Of course, GPs should be remunerated for patients who are registered, remain at the same address, are alive & MAY in the future require the help or advice of the GP ! But surely it's not too much to ask a practice to check up, by letter or by phone on a patient whom they have not seen for years !? Don't you sometimes wonder how they are, whatever their age, & whether they could benefit from some preventive medicine screening ? If you really haven't got time for that, then perhaps there are too many people registered in your practice for your practice to do justice to ?

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  • Sessional GP, 7.10am
    Doctor ! We are talking about the NATIONAL HEALTH SERVICE here, a wonderful service in the UK which was set up in 1948 to ensure that EVERYONE, however little money they have, will have access to health care from birth to death !! If you do not believe in this concept then I do not understand why you are working in the
    NHS !!

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  • A nice example from yesterday afternoon which covers 2 aspects of this problem and may help some of those non-GPs who do not appreciate what we are on about. 1 saw 2 people with a rash:
    One was a girl in her twenties who had noticed a faint, non-itchy rash on her neck the night before. In the morning it was improving but she thought she should get an urgent appointment. By lunchtime it had disappeared but she thought she had better come to get it checked anyway!
    The other was a guy in his forties who had quite nasty and itchy patches of rash for 6 weeks, probably related to excessive direct contact with a new cat and had booked a routine appointment 9 days before. He had tried Cetirizine, which helped a bit, Calamine which did not, then J-clothes soaked in vinegar(!) which was quite helpful but inconvenient!
    I had seen the man many times before in his capacity as the son of a lady who died a few years ago but did not realise he was a patient of our practice. He had not been seen since 1998 – eighteen years ago. His mother, on the other hand, had been seen at least monthly for many years and mainly as home visits in the last 2 years of her life.
    Hope that is helpful.

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  • June Greaves -

    There have already been several list cleansing exercises and every one has caused a lot of trouble and expense. For whatever reason, a lot of people do not reply to the letters and then get deducted, the most famous example in my county being the Chairman of the LMC got deducted from his GP!!

    You seem to think every member of the public will respond to a letter, well they don't, and they don't in big big numbers. List cleansing removes lots and lots of genuine patients.

    Your assertion that it's not too much for a practice to check up on someone they have not seen for years and your accusation that if we cannot then we have too many patients demonstrates a total lack of understanding of the perilous situation that general practice is in. Have you really not noticed that we cannot even cope with the numbers coming through our door every day never mind go chasing people who don't? We cannot reduce our list size because -

    1. It is a struggle to get permission to close our list and if we did manage that then we lose enhanced services and the vital money that brings so we would probably go out of business.

    2. We cannot reduce our boundary withour NHSE permission and guess what, they are reluctantto let practices do that

    3. Any meaningful reduction in list size means a meaningful reduction in income and with so many practices on the borderline of insolvency....... Yeah, that's a good idea June, got any more bright ideas?

    4. If we lose patients, where do they go? The neighbouring practices are similarly overloaded and can't cope with extras coming from us reducing our list.

    June, you have shown repeatedly that you are woefully ignorant of general practice, and your assertions and accusations are becoming downright insulting. By all means you are welcome to ask, but stop thinking you can tell us the morals or the solutions, because you are just exposing your ignorance of the situation.

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  • Dear June,
    Comments inserted.
    = surely we are NOT talking about non-attending registered patients BUT registered patients who are no longer in the area, have moved on or have died !?

    No we are not. Non responders are non responders whether dead or moved away or neither. We know if our patients are dead. If the system was so accurate and specific it only picked out those who had moved away then fine we'll have it, but DECADES of repeated ghost busting has shown that loads of non attending registered patients get removed. Please read my quote above, after a ghost busting we invariably end up re-registering 60% or more of the removed patients.

    =Of course, GPs should be remunerated for patients who are registered, remain at the same address, are alive & MAY in the future require the help or advice of the GP !

    Good.

    =But surely it's not too much to ask a practice to check up, by letter or by phone on a patient whom they have not seen for years !?

    Again read my posts. Yes this might (see later) be a nice idea in an ideal world that was fully funded. But as I pointed out GPs have NEVER been funded to do this work. So how can you expect us to suddenly start diverting effort and resources from the work we currently struggle with to contact the non attenders? So no this would be new work and new work needs new extra resources - with the caveats below.

    =Don't you sometimes wonder how they are, whatever their age, & whether they could benefit from some preventive medicine screening ?

    Please read my post - there is no evidence anywhere on the plant that preventive population screening works, look up the NHS Health Check program and see what a disaster that is.

    In fact the only common evidence of so called population screening is that 80% of the people who attend have no risk factors but they then attend more frequently with doctor induced health anxiety.

    = If you really haven't got time for that, then perhaps there are too many people registered in your practice for your practice to do justice to ?

    Please read the above. We protect our patients by not doing the unnecessary. It helps when we aren't funded to do it but no, as i have said above there is no evidence that that sort of cold calling actually helps patients, far from it, it converts a small proportion into hypochondriacs.

    I am afraid you would benefit from some reality checking. Many interventions feel like a good idea but there are often unintended consequences. You should not do things because they "feel" right but because they have been proven to be right. I hate to challenge your perception of the health environment but look it up yourself, the evidence for "prevention", except in some very specific niche areas, amounts to diddly squat.

    pleased to continue the enlightenment.
    Regards
    Paul C

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  • Well put Paul but I have an inkling that you are wasting your time.

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  • i think this is fair-we used to regularly check and cleanse our register in the 90s-so whats the big deal now-ah money but then why should the GPs be paid for people they are not serving???

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  • Dear Christopher,
    I fear you are right, look at the post above that follows yours, even some GPs don't get it!
    Regards
    Paul C

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  • I've not been a principal for several years so am not entirely up to speed with the minutiae of current data standards.
    Look at the extract from Capita's contract - 'requesting a list of all patients who are recorded as not having had contact with the GP practice in the past five years.’
    Do practices routinely record patients as not having attended for 5 years? I don't think so, you would have to do a search. If there is no record then there is no list.

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  • Thank you for the lecture, Paul Cundy !
    I appreciate that many patients are reluctant to change their lifestyles in order to prevent illhealth, however, I am disppointed that even you think preventive medicine is a waste of time !
    I'm also aghast firstly, that you have never thought it might be your responsibility to enquire if your patient, whom you haven't heard from for 5 years, still wishes to be registered with you ! After all, you are getting paid for the patient, a bit more than a phone call or letter, I think. And secondly that you think someone else should pay for the letter or phone call !
    Do you REALLY have to be paid for every bit of good medicine you carry out whilst practising your profession ?!
    These posts are revealing quite another side to some doctors in the caring profession of general practice.
    Sadly, decades of government bullying & restrictions has destroyed the good will in many professions, teaching, nursing, policing. I can see that it is happening to medicine too !

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  • I'm sorry 'Anonymous GP', I am unable to respond to your post as you have chosen not to let me know who you are. However, I can say that I do not think it is insulting to question someone's opinion when all they can say is petulantly 'You don't understand' without putting foward any valid argument, & as yet I have not heard any argument for why it is not the GP's responsibility to know if a registered patient still wishes to remain registered after 5 years silence. Except, 'But we don't get paid for doing it' !
    Surely, if the patient does not respond to a letter then they deserve to be off your register UNLESS they then respond ! That's human nature, surely, perhaps they will respond to the next letter in 5 years time!

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  • Sorry, it was an Anonymous Manager, not GP !

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  • Well said 'salaried GP @ 10.29pm', but you are a lone voice in the wilderness in these posts , I'm afraid, it's now a different world, sadly ! Hopefully, many of the GPs of your opinion are too busy to be posting on Pulse !

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  • Dear June,

    You continue to misunderstand, and if you dismiss detailed and educational explanations as petulant lectures then yes you will forever misunderstand.

    Your last comment; no we do not want pay for everything we do, what we want is enough resources to do these things; that could be more money coming into the practice, which we would not take as pay but invest in staff to do the work. Or our local NHS managers might want to second some of their staff to us. There are many ways it could be done but the usual way is to give the practice money and they then use it to do the work. We use the money coming into the practice to run the business, pay the staff and the salaried doctors, then whats left over is our pay and for the record many partners now take home less pay than the salaried doctors or locums they employ.

    But we do not have an endless supply of money or staff available, we have a limited resource. so we prioritise; and in that queue non attenders are at the back in the "it would be nice if we had the time or staff to do this but we don't" section.

    Then there's the point that you seem to moved away from which is it would not be pay for doing the work, it would be re-imbursement to replace the money we'd loose from our diminished lists. I say again, removing non attenders reduces the money in the practice but does nothing to work we have to do.

    And as to preventive care, read my posts again or do some Googling yourself, you will find the evidence for screening populations is that it usually causes more harm by generating health anxiety and certainly wastes resources, the "NHS Health Checks" policy is a prime example. I repeat; 80% of people who turn up for health checks have no risk factors, the at risk ones don't turn up because they don't care, its quite logical really; if you care about your health your likely to respond but you're also likely to not be overweight, a smoker or drinker. Thats why we we dont do it, its bad medicine and a waste of valuable time and money.

    Finally, I agree its difficult to remain empathic as a GP these days, one of the reasons GPs are so demoralised is the endless unrealistic expectation, the pointless box ticking, the continual criticism and ridiculous overregulation that we are subject to from people who don't understand what we do.

    Yours sincerely
    Paul C

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  • "Surely, if the patient does not respond to a letter then they deserve to be off your register..."

    Er.....no. We cannot easily remove patients who abuse the service yet the "non-deserving" who don't receive/open a letter or do not take time to prove their continued existence should be removed to teach them a lesson, as it were? The only suffering will be borne by the GP practice trying to operate with even less funding and thus the patients of that practice. When the deregistered patient needs a GP, he/she will just sign back on. Assuming, of course, that the practice hasn't gone under through lack off funding in the meantime. Moreover, there will be no second letter in 5 years' time because the patient will not have a registered GP and by the same token, he/she will be omitted from any screening programmes that depend on being registered.

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  • Dear Paul, & Anonymous GP @ 10am.
    I truly am NOT unsympathetic to your arguments with the government & subcontracted agents like Capita. I am deeply committed to the NHS & its principles.
    But it seems to me that, because you are SO angry with any government that EVERYTHING they try to do to save money is wrong unless they throw more money at you.
    IF Capita are not doing a good job, & the new system has only been in operation since March 2016 (!) then, YES ! complain about it & get it put right. BUT PLEASE, do not keep only asking for more money or funding, it is demeaning & is not appropriate for a caring profession.
    IF a patient has been wrongly deregistered by Capita, i.e. without being contacted by letter, informing them that IF they do not respond positively they will be taken off your register, then YES, Capita was wrong ! SO, complain about THAT, don't keep harping on about money & more funding !!!
    I personally have always found it incomprehensible that GPs are paid to do e.g.Children's vaccinations. Surely it is good medical practice to vaccinate children ? But perhaps I've misunderstood that system too ? Tell me more about the tasks you are paid to do !

    I fully appreciate that you all trained to be DOCTORS not MANAGERS ! But General Practice has to have management, every job has it's chores, so you have to employ managers, OR if you don't want to do certain onerous tasks (like checking if a registered patient you are being paid for still exists)then you farm these tasks out to e.g. Capita. Do you pay for regstration to Capita or is it a service which is thrust upon you by government in order to ensure that certain essential bookkeeping is done by all GPs ?
    What do YOU think is the solution to ensure that GPs are not paid for registered patients who do not exist ? Wouldn't that be an acceptable NHS cost cutting exercise which may free a bit more money to better fund in other ways the NHS in general & general practice in particular ?

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  • Dear Anonymous GP partner @ 9.10am !

    Are you seriously suggesting that GPs should be paid for patients who do not exist because otherwise they could not afford to continue in practice ??

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  • Dear June,
    Its almost as if you haven't read anything i've posted. Yes. Pleas go back a few pages to my explanation that the money we get fro non attenders subsidises the work we do for attenders. Ergo if you take that money away then there is less to pay for the patients who come through doors. To put this in proportion we were list cleansed a few years ago, we lost 12% of our list, that means 12% of our income. You try and run a business where 12% of your income can be taken away at any time. It took a year for the list to grow back again so for a year we had 12% les money but the same number of patients attending. Do you now understand?

    Answer to your question; YES practices cannot survive and might close.

    Regards
    Paul C

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  • Dear Paul,
    Who is talking about non attenders ???
    Certainly NOT ME, I've explained that already ! Surely we are trying to identify non existing patients, like those who have moved on & may have not even registered with another GP, perhaps even left the country !
    Do you honestly mean that, at any given time, 12% of your registered patients never make contact with you for years ??
    Why didn't the 12% REREGISTER immediately if there had been an error ?
    Complain about the methodology or, better still, do the cleansing yourself, it would be cheaper !!!

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  • @12.40
    No. That's not what I wrote.

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  • You do not need to provide a contact if you are well to care for someone. The fact that you burden yourself with the list size mentally and are an 'on demand' subscription is enough to be paid for. Idiots.

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  • Well then, Anonymous GP partner @ 2.25pm, what method do YOU suggest to identify registered patients who do not exist for whom some GPs are being paid, as one small way in order to save money in the NHS so as to be able to properly fund the NHS in general & general practices in particular ?

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  • Dear June,
    We're making progress, you're now focussing on the real ghosts. Would you like me to tell you how many of these real ghosts (patients still registered even though they have moved away or are dead, as opposed to being registered but just not using our services) there are? The number has been pretty static in the last 2 decades and would inform a cost benefit analysis of whether or not its worth trying to identify them.
    Regards
    Paul C

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  • Paul, it may not matter to the GPs (why should it ? !) but when multiplied it certainly will matter to NHS England or is it Capita !? That's REALLY what they are trying to find, isn't it ? Every little helps, as you have so frequently assured me !
    I thought GPs were notified of the death of a registered patient ?
    How many was it of your 'ghost' registered patients did you say were NOT non attenders in the last couple of decades ?

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  • Paul, on a brighter note !
    Have you seen that 'Justice for Health', the campaign of a group of courageous junior doctors, to which I & I'm sure you too have been contributing, have won their right to a judicial review in Sept. to determine if Hunt's decision to impose their contract is legal or not !
    Fantastic !!

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  • Dear June,
    Its not as simple as that. The words i used were "cost benefit analysis". There's no point in spending £1,000 looking for something worth £50. Since teh advent of PDS and the national centralised patient database the actual true ghost rate is so low it would never be worth the time and effort in trying to identify them.

    Looks like we've come to the end of the debate.

    Regards
    Paul C

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  • Dear Paul,
    I'm not quite sure just HOW you can know that your numbers are so low & so not cost effective to find, except IF the non attenders reregister after Capita cleansing. You will, of course never know what the numbers are in other GP practices. However, as you seem to be morally comfortable with your contribution at the moment, as you say, here endeth the
    debate. Good luck with your campaign to improve Capita's methodology !

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  • Dear June,
    And I thought it was over, perhaps you have a memory issue? You could re-read many of the previous 90 posts but perhaps i'll save the time, the reason we know what the numbers are is because its been done before, many times. We had them all removed and then they re-register, so yes we do know what the numbers are. it last happened across the whole of London 2 or 3 years ago. Unfortunately so few of the people who try to run the NHS are in post for long enough for them to carry over the past learning and thus stop these stupid ideas. Unfortunately we hang on in there, we remember, we are in fact the corporate memory for the NHS, unfortunately when we simply point out these past failures we get accused of being awkward, belligerent, arrogant or money focused.
    Regards
    Paul C

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  • Really! Capita need to get there act together first!! They don't even know where patients notes are. NHS England call us says we can't refuse this patient I told them this patient has been removed under zero tolerance hence the refusal only to find that capita and NHS England say this person has no zero tolerance and has no record of the last three GPS the patients been with although the patient has evidence!!!! I think they should get their own house in order first and NHS England

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  • Dear Paul,

    Good luck with your campaign to improve Capita's methodology !

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  • I have just read the article about NHSE wanting GPS to be protected from secondary care workload dump giving them more time for patients now this. Is it to give GPs more time to clean lists and not spend the time with patients?

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  • To quote Hudson in 'Aliens' :
    "How do I get out of this chicken*** outfit ?"

    June - you are quite funny. You remind me of the (increasing number of) patients who come in and seem to ask the right kind of questions but prove to lack the ability to compute what is said to them. In a consultation, if I'm asked the same question three different ways it trips a switch. Increasingly simplified vocabulary is then deployed (used) until such a point that the 'singularity' is reached and I then resort to drawing pictures. Paul has been very patient with you and has given some crystal clear descriptions of how remuneration works in the micro business that is a GP surgery.

    I particularly liked the 'don't you wonder how your patients are?' comment. That's quite laughable. We are hardened pros. We sort the **** out that everyone else ***** up, we're not your mum!

    As to it being 'unedifying' that I want to be paid for 'everything you do professionally'...well, um, that's kind of the point. Damn right I want to be paid and there is nothing wrong with that. Hey - next time you are moving house ask the Solicitor and Surveyor to do part of the job 'for the love of it'. Go on, and please do report back as to how that turns out.

    What you people can never understand is the consultation, how it works, what happens in it and how important it is to the smooth running of the health service.

    It looks so easy doesn't it, June. You could do it couldn't you?

    Go and sit yourself down in a room, with a PC and let 30 odd random members of the public have 10 minutes each with you. You've got that ten minutes to safely decide how to manage whatever they chuck at you.


    I'm going to give it 2 years to turn around but my private sector lifeboat is just getting the final lick of paint applied. The bespoke Italian sofas and Mark Levinson sound system are already installed.

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