This site is intended for health professionals only

Managers told to target immigrants and the elderly in national GP list-cleansing drive

NHS managers should consider targeting immigrants and elderly patients first in order to meet brutal new GP list cleansing targets next year, says guidance from a DH advisory body.

As part of the urgent drive to reduce variance in population and practice lists by 3%, first revealed by Pulse in November last year, new advice says PCTs should conduct ‘targeted campaigns' at certain groups to eliminate so-called ‘ghost' patients.

Written by DH advisory body Primary Care Commissioning, the guidance lists successful list-cleansing schemes and gives examples of targeted campaigns in South Gloucestershire, South West Essex and Berkshire West which resulted in the removal of 24,000 ghost patients.

They include sending verification letters to all patients aged over 90 to 100 years and annually to all immigrants. If they do not respond, then these patients will be given a FP69 flag to inform their GP the patient will be removed from their list.

They also say anyone who is out of the country for three months or more should be automatically struck off GP lists and that multi-occupancy dwellings should be targeted.

But the document does warn PCTs that successful schemes have enlisted GPs help, and that there is a risk of increasing costs if patients have to re-register.

It says: ‘Removed patients can subsequently be missed for national screening programmes. They will also cost more money once re-registered as they will register as new patients, thereby increasing their per capita cost.'

It also reveals the DH plans to launch a ‘diagnostic exercise' to flush out PCTs that ‘have still to carry out meaningful action' on list-cleansing and that the NHS Commissioning Board will have direct responsibility for ‘improving' list cleansing and link list accuracy to CCG authorisation.

Once authorised, CCGs will be set budgets based on their registered patient list populations - rather than the current system of PCT funding being dictated by national population estimates. With the CCG management allowance set at £25 per head, 2.5m extra patients could see CCGs allocated an extra £62.5m in management budgets alone.

Dr Paul Roblin, medical secretary of Berkshire, Buckinghamshire and Oxfordshire LMCs said schemes in his area – highlighted in the new guidance - meant practices were ‘suddenly losing huge chunks of patients'.

He said: ‘A lot of patients were given FP69s to which practices were alerted. The criticism was that practices responding to the FP69s were then getting no response from the agencies.'

Dr Philip Fielding, chair of Gloucestershire LMC, said ‘over-enthusiastic' list-cleansing in his area had been linked to Summary Care Record letters – and he had personally been wrongly de-registered.

‘It happened to me – a letter from my GP got sent to the wrong address and I got removed and had to re-register.'

‘If patients are wrongly removed, practices don't get paid and patients become invisible until they re-register and can be missed off screening programmes.'


GP list-cleansing goes national

Nov 2011

The NHS Operating Framework 2012/13 reveals that GP practices will be tasked with flushing out ghost patients before CCGs become authorised as statutory bodies in 2013. Read the article.


Nov 2011

Pulse reveals 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.

Read the article


June 2011

Pulse reveals nearly 40,000 patients were removed from GP practice lists in just one PCT yesterday as part of a tough new list cleansing exercise.

Read the article


March 2011

Pulse reveals up to 40% of patients could be stripped from practice lists within months under an unprecedented list-cleansing drive by NHS managers in London

Read the article