No, this isn’t about the popular film of 1984; it’s about the fact that GP patients’ lists are based on the number of registered patients. Inevitably, though, patients who use the NHS from the cradle to the grave move address, leave the country or sadly die. It’s always been accepted that an element of a patient list may consist of so-called ‘ghost’ patients and the powers that be take the view that practices might deliberately and knowingly retain on their lists, patients who, for whatever reason, might no longer be around. Personally, having worked in a Registration Department, I doubt whether deliberate fraud is that common.

Notices to patients

In the past, when a doctor retired, resigned or died, the patients registered on that list would receive a notice (a letter) setting out to whom their name would be transferred or they’d simply be asked to register with a new doctor. The number of returned, undelivered letters could be as high as 25% of the patient list. Arguably then, it was the primary care organisation of the day that managed the content of lists. Nowadays it would be the PCSE. No comment.

Here are some areas that you might choose to investigate:

• Registration details – Very much as a starting point, it’s always beneficial to take every opportunity to update patient registration details. Checks might include ensuring that the address of members of a household match perfectly, that details include a mobile phone number and email address. A simple form online or handed out at reception should suffice.

Typical breakdown of a practice with 7,500 patients

Let’s look at the use of media and then weigh up which method might produce a reply.

• Almost 83% of the UK population have a mobile phone.
• The number of households in the UK with a landline has fallen to 73%.
• 85% of internet users in the UK actively send and receive emails.
• 73% of internet users in the UK have a Facebook account.

• Demographics – Since the start of the COVID-19 pandemic, we have been blitzed daily with statistics on the progress of the pandemic. Sadly, since the start of the pandemic, a medical practice might have lost 15 patients. Based on a UK population of slightly over 67,000,000, a medical practice with 7,500 patients will, from birth to 65 years old, have around 500 patients in a five-year age band. After the age of 65, the number of patients in each five-year age band reduces to around 400 patients per five-year band up to the age of 75. A practice of 7,500 can expect to find around 300 patients aged over 80, but only one or two becoming centenarians.
• Average age – In the UK, the average overall life expectancy is 81 years. Another fact to note is that any death of a UK resident abroad is unlikely to be recorded in the UK. So, it may well be appropriate to carry out a search on anyone aged over 81 to see if they or a member of their family in the same household has received treatment and care from the practice, say, in the last three years.
• Gone away – Interestingly, in the UK, around 5% of people move house each year. Patients known to have gone away for more than six months will be removed from the list. Whilst there’s no official letter sent by the PCSE to patients when a doctor leaves, patients still receive a variety of screening invitations which may be returned as ‘gone away’ and result in FP69 enquiries.
• Outliers – For patients who live outside the accepted practice boundary, issue a letter advising that the practice may not be able to guarantee home visits and that the burden of dealing with such requests might well fall on other local practices.
• Duplicates – Search for duplicate patients living at the same address. Be careful, though, about differentiating between patients with the same date of birth and look out for birthdays that might be mid-year, 1^st
• Multiple occupancy – Search for residents of households with different surnames. One family might not have attended the surgery for some time and a check of sites such as Zoopla might indicate that the house has recently been sold. Patients who have no record of attendance may be removed from the list.
• University students – Normally students living away from home will register with a university medical practice if they spend the majority of their year in residence. They may change their residence during their time at a university. It’s appropriate to review their registration each year to ensure continuing residence, but after three years they may have returned home or moved elsewhere.
• Residential homes – There’s likely to be an increased turnover of patients living in residential care and nursing homes compared with general housing areas. It’s imperative that the correct postal address is used for each resident of a residential home.
• Migration – On average, homeowners move house 11 times during their lifetime, either to another location in the UK or they move abroad. Practices tend to rely on patients notifying them of a change of address or they make the assumption that deletion from the practice list will be triggered by registering with a new doctor/practice. There’s little point in looking for a needle in a haystack. However, practices might review non-attendees of long duration, e.g., five years at locations or residences known to house transient residents, such as hostels, hotels, residential park homes, etc.

Do you have a policy?

A practice Registration Policy itself is straightforward enough; unless it has an approved CLOSED list, the practice is obliged to accept patients without prejudice. However, the steps each practice might take to manage their list, and to avoid any accusations of fraud or irregularities, might vary according to the location and circumstances of the practice. My view would be to set out in a policy an approach that’s both doable and fits the circumstances of your practice. It would be counterproductive to try every search under the sun, but a selective and not too time-consuming approach would probably be the most viable option.

Robert Campbell