It reads like a script from Ghostbusters. Millions of phantom patients are haunting the NHS, and our heroes at the Department of Health face a race against time to wipe them off practice lists before it is too late.
At least, that is certainly how ministers would like to frame it.
In evidence to the Commons public accounts committee, the DH said the number of people registered with GP practices in England was 2.5 million higher than estimates from the Office of National Statistics of the country’s population. Ministers are in a panic, because the budgets of clinical commissioning groups are due to be based on their registered populations and the DH is desperate not to hand CCGs too much cash.
And so GPs face an unprecedented national programme of list validation, which threatens to replicate the traumatic experience at NHS Brent, where 38,000 patients disappeared from lists almost overnight. Practices stand to lose 5% of patients on average, but the number of ghosts is apparently not evenly distributed, and some could be deprived of a quarter of their lists.
The DH’s calculations hardly look watertight. Ministers are assuming the Office for National Statistics estimates, based on 2001 census returns, are right and the practice registration figure wrong, but could it be that GP registrations simply offer a truer picture than numbers extrapolated from decade-old data?
And the DH admits registrations will always be slightly inflated, because of the inevitable overlap when a patient moves practice – could it not take that into account when setting commissioning budgets? But even if you accept there are huge numbers of non-existent patients on practice lists and that this presents a serious problem for the NHS, does that justify the actions the Government is proposing to take?
Ministers plan to aggressively ‘accelerate’ the list cleansing NHS managers are currently doing. PCTs will be assessed to see if they have taken ‘meaningful action’ against practices, with the possibility they will face some meaningful action of their own if found to have failed.
The NHS Commissioning Board is to directly intervene to toughen up list-cleansing activities. And, most alarmingly of all, the DH is planning to make it a requirement of authorisation that CCGs have removed patients from the lists of member practices.
It doesn’t take a financial expert to appreciate practices will be desperately destabilised if they lose anything like a quarter of their patients, or a lecturer in sociology to foresee the tensions that could arise if CCG leaders are instructed to take urgent action against their colleagues.
GPs are being asked to take on huge new responsibilities at a time of massive financial pressures. The profession needs financial stability and harmony – not instability and division. The deal we revealed last week between Londonwide LMCs and NHS London points the way forward. They agreed to reject one-hit list cleansing, with its alarming lurches in practice funding, in favour of a gradual, rolling programme.
If the DH took that approach nationally, it might miss its artificially imposed deadline – and have to slightly adjust its commissioning funding formula – but it could just avoid further alienating GPs.