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Tens of thousands of ‘ghost patients’ wrongly removed from practice lists, GPs estimate

Thousands of people in the UK may have been wrongly identified as ‘ghost patients’ and removed from their GP practice lists in just one year, a Pulse investigation has discovered.

A Pulse survey found that 153 of 527 GPs (29%) said patients on their practice list had been erroneously removed through list cleansing during the previous 12 months, and the total estimate of patient numbers was about 6,700. Extrapolated across the whole of the UK’s 10,100 practices, the figure rises to about 130,000 patients.

Some GPs surveyed said that several hundred patients’ names were removed from their practice lists in the 12-month period, while one gave a figure of 1,000. Another GP reported that one three year-old boy had been removed for not returning an enquiry letter.

Survey respondents and GP leaders said the list cleansing mistakes variously resulted in patients directing anger at GPs, a reduction in earnings, and a weekend of extra work for a GP in gathering evidence to show that patients should be reinstated.

Pulse reported last year that around 25,000 patients had been wrongly being kicked off practice lists. However, despite the reforms to the NHS, the numbers seem to have increased since.

The NHS England London local area team had targeted 700,000 so-called ‘ghost patients’, sending letters to patients who had not been in contact with their practice in 15 months.

Dr Adedayo Adedeji, a GP in Dagenham, said more than 1,000 were wrongly removed from his practice list.

Dr Jacqueline Marshall, a GP in Uxbridge, Middlesex, said: ‘I’ve had to spend weekends in the practice obtaining evidence to prevent patients being removed erroneously. The list included the most vulnerable, for example older people, people with dementia, and mental health patients who did not reply to letters.’

However, GPs from outside London also reported having patients removed.

Dr Sanjeev Juneja, a GP from Rochester in Kent, said a three year-old child was taken off hers. She added: ‘We kept him on the books, as the family was still not excluded. The exclusion was due to the three year-old not returning a letter sent by the Kent Primary Care Agency.’

Some patients are unable to reply to letters because English is not their first language, she added.

Dr Shalini Gadiyar, a GP in Rochdale, said removals can result in anger directed by patients towards GPs.

GPC negotiator Dr Dean Marshall said: ‘Patients can get very agitated when they are wrongly removed, because they have no idea why it has happened. It can also cause an administrative burden for the practice.’

NHS England head of primary care commissioning Dr David Geddes said that list cleansing is necessary because there is a ‘significant financial burden on NHS resources if patient lists are overstated.’ He added: ‘Maintaining accurate lists is crucial because commissioners need to have an accurate knowledge of the populations for which they have responsibility.’

‘This enables them to plan accordingly. It is an on-going process which avoids the build-up of ghost patients, which artificially inflates the size of patient lists. It is very important to ensure that patient lists are accurate because NHS England is shifting to funding medical services contracts through a global sum payment that pays on a per patient basis.’

‘NHS England has explored good practice regarding list cleansing and will publish the results in a new NHS England policy document next month called “Tackling list inflation for primary medical services”.’

Area teams will work with GPs to investigate the effectiveness of this policy over the next 12 months, Dr Geddes added.