GP practice managers are hitting back at recent news stories stating that the NHS pays £543m a year to GPs for 3.6 million ‘ghost’ patients who don’t exist.

A number of newspapers reported on the story first published by the Mail on Sunday that despite a crackdown launched three years ago on so-called ‘ghost patients’, the numbers have risen at a rate of almost 6,000 a week – and that doctors in England receive an average of £151 a year for each patient on their books, whether they see them or not.

Factually incorrect

Practice managers have responded to the articles by highlighting factual errors. Comments made on the Practice Index Forum, for example, questioned the £151 per patient figure. Remarks stated that the figure was closer to the £80 to £85 mark – and while £151 is theoretically achievable – it’s not going to happen if a patient is a ‘ghost’ and is therefore not using a practice’s services.

Another very valid comment on the Practice Index Forum said: “The shattering ignorance of this headline includes failure to understand (or bothering to find out) that the funding model for core contract activity is already based upon a principle under which a significant proportion of Practices (the majority of those in my locality) have their actual list size reduced, in some cases by thousands of patients as a result of the Carr-Hill weighting calculation before their payment is made. And that this is updated quarterly.”

Thanks to potential discrepancies like those listed above and the sensationalist headlines that at first glance laid responsibility firmly at the door of GP practices, it’s easy to see why practice managers are upset. Some say the articles have made their blood boil, while others say they have seriously demoralised already pressured practice teams.

Not in practice interests

Another common criticism of the various newspaper articles – especially the headlines and front-page snippets – is that GPs are being blamed for the problem. While there are clearly a small number of unscrupulous practices for whom it pays to knowingly keep hold of ghost patients (and who tarnish the whole profession), many practice managers suggest that it’s the system and the NHS itself that’s to blame.

One PM told us: “It’s actually in the interests of well-run practices to remove ghost patients from lists. The £85 or so we actually receive per patient doesn’t go very far when it comes to admin costs. Constantly sending QoF invites, for example, costs money. Plus, if we cleanse our practice list we can increase the value of child imms and so on.

“That said, I’m sure we do have some ghost patients on our list, as most practices will, but you can’t blame us when the NHS powers at be are failing to do their job. For example, isn’t the NHS Spine supposed to control the number of registrations per patient? And what about the millions being given to Capita for them to sort out the problem? The Mail’s article itself highlighted how Capita’s performance on the £330 million contract was last month described as ‘a shambles’ by the Commons’ Public Accounts Committee – we need much of an integrated, multi-agency approach that delivers joined-up thinking. Just for once, that would make a refreshing and necessary change. And let’s face it, we do need help. Patient churn is, in my experience becoming worse – we’re close to 15% per year now, and with my area having a growing student population, a real problem with homeless people and a lot of expats, we don’t have the time or resource to police our list like we want to.”

A good example of the above was shared in the Mail on Sunday’s article – it pointed out that the Government’s Tell Us Once system, which is designed to allow bereaved relatives to inform all departments and agencies about a death by ringing a single number, still does not pass such information to GPs – despite the fact it would be extremely helpful.

As Professor Kamila Hawthorne, vice-chairman of the Royal College of GPs, said: “Ghost patients are the result of a records management issue from the infrastructure that manages patient registers, not a case of surgeries profiting by keeping patients on their lists when they shouldn’t be there.”

Hindrance

Another PM, writing on the forum, outlined a common problem that is contributing to the ghost patient problem: “I am constantly battling with PCSE to accept the deductions of patients I know have moved, registered elsewhere and have been given a month’s notice. It is completely unacceptable that PCSE (Capita) will not accept I have given notice and then will wait a further month or two before they accept the deductions. This is happening so often – to date I’ve had on average 35 patients a month waiting several months. So, we do try to keep our list up to date, but there are other powers that hinder the process.”

Practices are also caught between a rock and a hard place when it comes to cleansing lists. Dr Richard Vautrey, chairman of the GPC, warned that any future ‘list-cleaning’ initiatives must be carried out with caution. “There will always be a discrepancy between the two figures and it’s important to ensure any list cleaning exercise is done carefully, is proportionate and does not add unnecessary workload on to already pressured practices.”

It’s also worth remembering that overzealous list cleaning drives by primary care organisations in the past have led to legitimate patients being forced to re-register with their GPs. Practices are faced with a tough balancing act.

As was quoted in the media, NHS England is working with Capita and GP surgeries to transform this process, make it digital and any savings identified will be ploughed back into the NHS. Whether that will work is anybody’s guess!

This topic is discussed in much more detail on the forum thread – click here to read in detail – and is well worth a read. We’ll be following up soon with an article on how to manage practice lists and, in the meantime, here’s a link to a handy article on list churn – a topic that seems all the more relevant given the recent headlines.

Forum thread for this article is here. 

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