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Patient list churn – they come, they go, but what level is acceptable?

Patient list churn – they come, they go, but what level is acceptable?There has been much discussion recently on Practice Index about patient lists. Some practice managers have been talking about list closures, others about deleting ‘ghost’ patients. However, one question we received – about the turnover of patients on a practice’s list – really made us think – and try to find some answers about what level of churn is normal, what impacts on numbers and why it matters to practice managers.

The first thing we thought we would do is see if there’s an average rate of churn for practices across the UK. Having asked the various management bodies and data holders, the answer here is a big NO! While some figures were shared, there was such a huge variance between them that there was nothing we could reliably publish. We’ll keep digging on this one, so do check back soon to see if there’s an update.

Variations

What our research very quickly showed us is that there’s a huge variation in patient turnover from practice to practice, area to area. These variations would actually render a national average pretty meaningless anyway. For example, in rural Cumbria one practice we spoke to said their annual turnover is less than 3%, while a practice in north London said their figure was closer to 30%. One practice told us their figure had reached 46% – prompting them to create a part-time admin role to deal solely with new patient registrations!

This variance is largely down to social demographics. Big cities tend to have more mobile populations than rural areas, areas with large universities will naturally see a higher churn, as will areas with greater migrant populations – government stats show that migrants tend to initially settle close to points of entry, before moving on within a year or two.

Even then, practices within cities can’t benchmark themselves against each other – population churn varies enormously from borough to borough. The Office for National Statistics (ONS) provides some insight on this. London’s internal churn rates (within borough) vary from 36 per thousand in Havering and Redbridge to 61 per thousand in Wandsworth. The overall churn rates (including out of borough moves) varied in 2008-09 (latest available data) from 119 per thousand in Havering to 321 in Hammersmith and Fulham.

Benchmarking

While there is variation, patient churn can be a useful indicator of practice performance, as a PM told us: “We contacted our local council who were willing to share general population turnover stats. Those figures can also be found online with a bit of digging. We then matched our turnover percentage to that figure to get an idea, albeit rough, of how well we were performing. Our churn was lower, much lower.”

This, however, set alarm bells ringing as the practice churn was much lower than the population churn, prompting a review of the patient list.

“We were a good 15% lower than the population churn figure, which made us wonder! So, we reviewed our list and pulled out details of patients who hadn’t used any service for two years. We contacted each one and discovered around 5% of our list were ‘ghost’ patients. That caused another headache regarding what we do with those patients, which we’re yet to resolve!”

This topic has recently been discussed on the Practice Index Forum where, amongst many useful comments, one PM points out how removing ghost patients can boost QOF figures – the full thread can be viewed here.

Financial implications

Patient churn is, of course, important to practices from a financial perspective. The practice funding formula recognises that patients in their first year of registration in a practice tend to have more consultations than other patients with otherwise similar characteristics. An uplift is therefore applied to all new registrations. At a practice with 46% turnover, that figure can be sizeable and much needed.

If overall patient numbers are remaining relatively constant, regardless of the level of churn, then there’s nothing to worry about. If, however, list size is slowly decreasing year-on-year then it could point to issues with service levels or patient dissatisfaction, which could be adversely affecting practice income. That’s a story for another blog!

So, overall, patient churn is not something practices should be afraid of, as long as overall list numbers remain healthy. Turnover can also be a useful performance indicator when matched with local population data – and that really is the key indicator to work with.

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2 Responses to “Patient list churn – they come, they go, but what level is acceptable?”
  1. Imran Mir Says:

    Good article. It would be helpful to know how to calculate the Patient Churn Rate. I would use the following:

    Churn Rate for 2016:
    List size on 1.1.2016 – List size on 31.12.2016 / List size on 1.1.2016

    Is this correct?
    Thanks.

    Reply

    • Practice Index Says:

      This looks correct to us. In a nutshell, to get a percentage, it’s the difference divided by the original figure x 100.

      Reply

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