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The waiting game

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)

  • Reduce income increase workload. (Sound of face hitting desk)
    Do they not know what's happening in general practice at the moment?

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  • Whilst the NHS collapses our government want to employ hundreds of lawyers to argue the tariff price of garden peas with Europe and also kill off our greatest NHS asset the wonderful patient centred GP.It's time to tell our patients the truth...You cannot trust the Tories with NHS..Wake up everyone before it's gone for good.I think now it's time to walk to London and we go with the 80% tolerant fabric of UK who were too busy working whilst haters were shouting their lies for months.

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  • GP: How are you doing?
    Patient: Sorry to bother you doctor, but I was worried that I might get struck off your list so I thought I'd just pop in to have a check.

    Multiply by several hundred thousand across the country

    God help us.

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  • They're going to get Capita to do this? That's success guaranteed then

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  • Azeem Majeed

    To make the 'counter-argument', the NHS does need accurate population registers and so there is some need for list cleaning. However, list cleaning also inconveniences patients and cuts a lot of funding from practices. My own practice (in London) along with all other local practices has experienced regular list cleaning in recent years and each episode has a negative effect on the practice and our patients. Of course, if practices were paid by workload rather than capitation, list cleaning would be less of an issue for practices.

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  • The current system is very unfair.

    Honest practices are effectively penalised for routinely removing patients those that have left.

    Others have a narrative that self-justifies not doing so, and profit as a result.

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  • Payment by activity would sort this out. Has this been proposed by nhse yet? Thought not

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  • Peter Swinyard

    this disadvantages the illiterate (more patients than you might imagine) and subliterate, those who are terrified of any letter from officialdom and don't open it, those who have moved within area and not remembered to tell us and those whose first language is not English and who will usually ignore those things they cannot understand.
    There are better ways of spending our time than playing ghostbusters.

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  • Really! I'm beginning to think that the conspiracy theorists among you regarding Tories surreptitiously privatising the NHS has some grain of truth. Either that or JH was bullied at school by someone who later became a GP and he has been harbouring his vengeance ever since. I bet he slowly pulled the legs off the daddy long legs when he was younger; you know the sort

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  • June, the problem is you have just created a whole load more workload, more expense for practices with an aim of reducing their funding.

    Given the aim is to increase funding to general practice and reduce workload i would argue it goes against both of those.

    I have just run a very quick search to see who hasn't has a consultation added or medication issued in the past 5 years.

    The results are ever so surprising. 87% of these patients are in the 5 (out of 14) payment bands for which we receive the least amount of money per patient. Why? Because statistically they give us the least work to do and why? Because many of them don't visit the surgery or request medication for many years!

    Yes they need to do something to those practices who are deliberately breaking the rules but creating additional workload for the majority of the circa 8,000 practices is not right.

    If they want to do it - fund it! It would cost about 3p per patient to fund or £1.6m nationally. Oh and commit to recycle any additional savings (about 20k ghosts needed to be found) back into the global sum.

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