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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.