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NHS to investigate GP ‘fraud’ in retaining ghost patients

The NHS anti-fraud body is to investigate general practice in a bid to crack down on apparently incorrectly claimed GP capitation fees.

NHS Counter Fraud Authority is prioritising work that will involve looking into so-called ‘ghost patients’ – people who may have died or moved away from the practice but still remain on the patient list – in a bid to challenge what it calls ‘fraud’ within general practice. 

But GP bodies have pointed out that ghosts patients are a result of records management issues, and have said that any ‘insinuation’ of fraud on the part of GPs is ‘shocking’.

GPs have also pointed out that the current funding system for general practice accounts for practices having a number of ghost patients on their lists.

A document outlining NHS CFA’s priority areas for action in 2019/20 revealed plans to tackle potential fraud in relation to GP capitation fees.

The document said: ‘This priority area will focus on GP capitation fees. We will work with colleagues in NHS primary care to increase confidence in our assessment of the losses to fraud in this area and form a basis for fraud prevention activity.’

According to the BMA and RCGP, the authority will also investigate GPs who are claiming funding for non-existent patients.

Both organisations have expressed outrage at the NHS CFA’s new focus on general practice and have strongly denied suggestions that GPs are ‘complicit in defrauding the health service’.

RCGP chair Professor Helen Stokes-Lampard said: ‘The insinuation that GPs – some of the most trusted professionals in society – are complicit in defrauding the health service is shocking and will be incredibly hurtful for hard-working GPs and their teams who are struggling to deliver care to more than a million patients a day across the country, with insufficient time, resources or workforce to do so.

‘It is, of course, important to make sure that patient lists are kept as up-to-date as possible, so that resources are used where they are most needed – and our administrative staff already spend a lot of time processing patients’ notes when we are informed that they have died, left the surgery or moved elsewhere.

‘But so-called “ghost patients” are nothing sinister – they are the result of a records management issue, not a case of surgeries deliberately profiting by keeping patients on their lists when they shouldn’t be there.’

The responsibility to vet GP lists for patients who are registered but no longer attend the practice was part of Capita’s original contract, when it took on primary care support services in 2015.

However, the exercise was put on hold amid the upheaval faced by practices in the wake of the outsourcing, which saw NHS England cut 40% from its budget to provide such services.

BMA GP Committee chair Dr Richard Vautrey said: ‘Data checks on practice lists is currently the responsibility of Capita, which we know has overseen a litany of failures in its running of GP back office functions. Practices, as always when this has been carried out in the past, will be doing all they can to engage with this process.

‘Anti-GP rhetoric that attempts to distract from the failure of Capita to undertake list revalidation properly only undermines the morale of hardworking practices.

‘Any list revalidation exercise must be done responsibly, as there is a real risk that patients could be removed from lists for not receiving or responding to a letter.’

An NHS CFA spokesperson said: ‘This is an area on which the NHS CFA has limited intelligence, hence the choice to focus some resource this year in filling the intelligence gap.

‘The priority is to better understand the vulnerabilities there may be in GP capitation and propose how these can be addressed.’

They added: ‘Previous data analytics work identified a discrepancy between the number of individuals registered as residing in England and the number registered at GP surgeries.

‘Our priority this year will be to assess whether these discrepancies remain and if they do, conduct further analysis to establish their nature and whether part of this is due to fraudulent activity or not.

‘This will complement the work currently being undertaken by NHS England by working collaboratively with them to target specific areas of loss. The precise nature of the work being done is being developed at present, and involves a number of stakeholders.’