Exclusive The Department of Health is planning a national list-cleansing campaign to remove up to 2.5 million ‘ghost patients' from GP lists across England, in a move that could cost an average practice as much as £30,000.
Ministers want list validation to be stepped up nationwide in an effort to clean practice lists by April 2013, when clinical commissioning groups will be set budgets based on their registered populations.
CCGs are set to be handed responsibility for pruning member practices' lists as part of the authorisation process for commissioning, raising fears the policy could further drive a wedge between their leaders and grassroots GPs.
The shift to setting budgets by registrations, rather than the population estimates used for PCT funding, has sparked alarm among politicians that cash could be handed over for patients who don't exist.
A Commons public accounts committee report claimed in some areas the number of patients registered at practices was 25% higher than the estimated local population.
DH officials said their latest estimate was that GP lists held 2.5 million more patients than population estimates, and revealed a major clampdown that could see an average of 330 patients removed per practice.
The DH plans to launch a ‘diagnostic exercise' to flush out PCTs that ‘have still to carry out meaningful action', hand the NHS Commissioning Board direct responsibility for ‘improving' list cleansing and link list ‘accuracy' to CCG authorisation.
Una O'Brien, DH permanent secretary, told the committee: ‘We are undertaking list cleansing and about to take that a step further in the expectations that will be placed on PCT clusters and CCGs. Our intention is… accuracy of lists is included in authorisation of CCGs, so there is a stop point where they have to demonstrate lists are sufficiently up to date to enable them to take on budget responsibilities.'
A DH spokesperson said: ‘We are working to ensure PCTs give priority to updating GP lists prior to the NHS Commissioning Board taking on responsibility for commissioning primary care [in April 2013].'
The exercise is due to start when the Audit Commission publishes data from its existing programme, aiming to cut duplicate registration. Its report was due this month, but is now expected in January. Experts at RS Medical Accountancy estimated losing 330 patients would cut an average GMS practice's funding by just under £30,000.
DH officials said list variation was highest in London. GPs in the capital expressed strong concerns over the plans, which follow a series of controversial exercises this year, most notoriously NHS Brent's removal of 38,000 patients in a week.
Dr Tony Grewal, medical director of Londonwide LMCs and a GP in Hillingdon, north-west London, said: ‘Vulnerable patients, migrants and multiple-occupancy addresses are among those adversely affected. Some practices are very seriously hit.'
Dr Richard Vautrey, deputy chair of the GPC, said: ‘Practices will be very concerned about this and so should patients. In recent months we've heard numerous examples of patients who are angry they've been wrongly removed from their practice. It is right to ensure lists are accurate, but it must be done with care and sensitivity.'
How we lost 1,500 patients
Dr Martin Lindsay, chair of Haringey LMC, saw 1,500 of his practice's 11,500 patients removed in a list-cleansing drive last July.
‘We had three times the number of patients removed that should have been removed – that kind of thing harms patients and practices.'
‘It does GPs absolutely no favours to have overinflated lists. If anything, payment by results means you are better off these days having a slightly smaller list and hitting targets. The problem comes when they keep trying to clean lists again and again. It takes up all of our staff's time and takes away from clinical work.'
