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Thousands of patients wrongly removed from practice lists as part of managers' £85m savings drive

Exclusive Thousands of patients have been forced to reregister with their GP due to an NHS cost-cutting programme that targets the very elderly and children for removal from practice lists.

A Pulse investigation reveals that nearly 12,000 patients have been forced to re-register with their GP since April 2013 after being removed from their GP’s list by managers.

GPs say the programme to check their practice lists is putting vulnerable patients at risk, with some missing vital check-ups as a result of not being on a GP list.

The figures – obtained under the Freedom of Information Act - are the first to show the results of the programme begun by NHS England last May to validate practice lists to reduce the number of so-called ‘ghost patients’ registered by GPs and save the NHS £85m.

They reveal that the re-registration rate for this programme is running at around 14% of those patients targeted, double the rate for previous programmes run by PCTs.

The programme specifically targets patients aged 100 years or over, children and others who do not attend their vaccination appointments and people living in homes with ‘apparent multiple occupancy’.

NHS England released guidance in May 2013 that said area teams were expected to engage in ‘regular proactive list management with general practices’ to ensure that practices are being paid for genuine patients and that those with 5% more registered patients than head of population ‘will be benchmarked against their achievement in reducing lists’

Results of the Pulse investigation, include:

•  Some 20 of the 25 area teams have begun work to validate GP lists since last yea

•  Of the 10 able to provide figures, they have removed some 83,420 patients from lists so far

•  11,894 of these were subsequently forced to re-register with their GP as they were genuine patients, resulting in an error rate of 14%

•  Extrapolated across the country, this could mean that up to 35,000 patients could be removed from practice lists and be forced to re-register with their GP due to the programme

•   The Thames Valley area team had the worst rates, with re-register rates of more than 40% for its scheme, 32% for the Birmingham area team and 14% in Leicester and Lincolnshire.

GPs say that the list cleansing drive is causing distress to patients, including leading to angry scenes in waiting rooms, while others claim that patients are being removed without even being contacted.

Dr Louise Irvine, a GP in Lewisham, south east London, said that ‘loads and loads’ of her patients have been wrongly removed from her patient list. She added: ‘Patients were very distressed at being removed. Sometimes there are angry scenes at reception, which is a distressing situation for everyone.

‘We try to re-register them as quickly as possible to stop this interfering with their care or their ability to get an appointment, but it leads to a lot of time being spent by our receptionists who are already very busy.’

Dr Sanjeev Juneja, a GP in Rochester, Kent, said that a child has been targeted – because the three-year old failed to return a letter. ‘Vaccinations were missed as child was not listed,’ he said.

Dr Tony Grewal, medical secretary of Londonwide LMCs, said that NHS England’s targeting of patients in multi-occupancy residents were adversely affecting vulnerable patients from overseas.

He said: ‘It is rare a letter sent to somebody living in a multi occupancy residency will get to the right person.

‘Very often these people don’t speak English as a first language, or don’t understand the importance of a letter they get from NHS England. Those seem to be the higher proportion of the removals.

‘But they are also more likely to be a vulnerable group and it has been a concern for us.’

An NHS spokesperson said: ‘NHS England takes all possible steps it can to contact patients and minimise the number who need to re-register - but there will always be some circumstances where patients do not respond and at that point we have to assume that they have moved away from that address and are therefore not in reality receiving services from that GP. Patients can always re-register with that practice or another, it is therefore incorrect to say that they have been “wrongly removed”. ‘

Pulse reported last year that PCTs were taking part in list cleansing exercises, with 7% of patients that had to be removed under list-cleansing schemes having to re-register with their GP in 2012/13.

Readers' comments (5)

  • This is a pure gaming exercise. Patients are not registered at 2 different practices simultaneously so are therefore not increasing costs to the NHS. There are a small minority of patients who move abroad and die that we don't know about who become 100 yr old ghosts. To be honest I try to identify them when reviewing qof as they can effect this. All practices have registered patients who move to a different area and don't re-register until they need to see a GP so it balances out. This is purely a drive to pay GPs less and threatens to destabilise practices as well as causing unnecessary distress and risk of harm to patients. Practices also rely on having some patients that don't consult to make up for those that consult more frequently due to the current funding formula. Otherwise we might as well move to a payment by consultation system then none of this would matter but it would cost more than the 'all you can eat buffet' of general practice as it currently stands.

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  • we have had so many of these........ and then they need to go through the rigmarole of re registration. On systmone all the old repeats are automatically removed and have to be individually reinstated by Dr Muggins.

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  • I am surprised to find that many patients, who attend the surgery for consultation find that they have been de-registered as they have not responded to a letter from the NHS.
    We have to re-register these patients, increasing our work but we lose the money for the period when such patients were not on our or anyone's list.
    A very noble way of saving money

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  • Vinci Ho

    Yes. The debate could be whether we stick to this current payment system or move to payment by consultations.
    BUT, the debate will only be logical if NHSE changed its attitude. One cannot negotiate with those who have no interest to show any respect. The notorious behaviour and attitude simply neglect anything or everything . Cheaper the better. Cannot see any way other than confrontation.

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  • It is time the government left GP's to do what they do best, care for patients! I bet my GP works harder than any MP, and longer hours for less money!
    Roll on the next election!

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