This site is intended for health professionals only

List-cleansing drive ‘to wipe off 40% of patients’

By Gareth Iacobucci

Exclusive: Up to 40% of patients could be stripped from practice lists within months under an unprecedented list-cleansing drive by NHS managers, Pulse can reveal.

Tough new measures will see every patient who has not visited their surgery within the last six months and who fails to respond to two written notices wiped from targeted practices' lists.

NHS Shared Business Services, a joint venture between private firm Steria and the Department of Health, is implementing the measures in NHS Brent, and is in the process of developing ‘added-value services' for a national list-cleansing programme. The company works on cost-cutting measures with around 50 PCTs across the country and has previously run list cleansing across seven London PCTs – claiming to have saved £3m per year.

But an LMC report has found practices in Brent stand to lose 10-40% of their patient lists under the measures, and has warned some could fold as a result.

NHS Brent estimates it has 41% list inflation and has signed a deal for an undisclosed amount with NHS Shared Business Services to follow up on an estimated 120,000 non-responders to previous list-cleansing schemes. It is forecast the PCT could save £268,000 under the scheme.

GPs have been given just six months to appeal against patients being removed from their lists, and face a huge administrative workload after being told they must telephone or write to each patient or invite them into the surgery for a face-to-face appointment. LMC leaders are furious that all patients in practices who did not respond to initial letters are being targeted for removal in one go, rather than in smaller groups.

Dr Helen Clark, medical director of Londonwide LMCs and a GP in Brent whose own practice stands to lose almost one in five of its patients, warned: ‘This shotgun approach of hitting every patient in every practice all in one go will create casualties.

‘It's not the principle of keeping lists clean, it's the way the PCT has done it. If it did a phased process over time then that would be much more manageable in terms of practice staff and time, and it wouldn't have so many at-risk patients hit in one go. It's disproportionate.'

Dr Jacqueline Marshall, a GP in Brent whose practice faces losing 1,000 of its 6,000 patients, said: ‘We are trying to go through and verify the list. But there's only a certain number of hours in the day. Where does that leave the rest of the patients?'

Dr Marshall said she had compiled a report for the LMC, finding many practices would not be viable after the measures. She warned ‘the most vulnerable people in society' were at risk of being removed, including the elderly, the housebound, the disabled, and the mentally ill – as well as at-risk children and ethnic minorities.

But Jo Ohlson, Brent borough director of the Brent and Harrow NHS cluster, defended the scheme, insisting: ‘Patients are only removed when practices have been unable to confirm a patient is still legitimately registered with the practice.'

A spokesperson for NHS Shared Business Services said vulnerable patients were assisted by the provision of translation services, and stressed that the timeline for appeals was set by GMS regulations.

‘This gives GPs some six months to confirm that an individual is currently an active patient,' the spokesperson said.

How list cleansing is being ramped up

• NHS Shared Business Services is writing follow-up letters to more than 100,000 patients who have not responded to letters from their PCT asking them to verify their registration at their practice.
• Patients who fail to respond to the follow-up letters are given FP69 notices, which recommend their removal from practice lists.
• Practices are being given just six months to verify all the affected patients, or face having them all removed from their list at once.
• In order to retain patients, practices must prove that the patients have either had an appointment, written a letter, had a telephone conversation
or been issued a prescription within six months of the first letter being sent.

Dr Helen Clark: her practice faces loses one in five of its patients