GPs dispute Audit Commission claims list cleaning ghost patients saves £6m

GP leaders have questioned Audit Commission figures showing the removal of 'ghost patients' has delivered an annual saving of £6.1m to the NHS.

Dr Chaand Nagpaul: Duplicate patients are rare
Dr Chaand Nagpaul: Duplicate patients are rare

A report on the national duplicate registration initiative run by the Audit Commission in 2009/10, stated that the initiative resulted in the removal of over 95,000 patients.

As each patient’s registration is worth on average £64.59 a year to a practice, these deleted records have saved £6.1m in one year alone, the Commission said.

However GP leaders have question the validity of the figures claiming that many de-registered patients had actually re-registered with their GP.

According to the Commission, over 32,000 deceased patients and over 29,000 duplicate patients were identified and removed from GP lists during the duplicate registration initiative, and these two areas led to the greatest patient registration deductions overall.

However GPC negotiator Dr Chaand Nagpaul questioned the report's claims that most deregistrations resulted from identifying deceased and duplicate patients.

‘We are not aware of any significant numbers of patients remaining on GPs' lists after they have been deceased,' he said.

Dr Nagpaul added that there were often ‘anecdotes’ about duplicate patients on practice lists, but in reality  that duplicate patients were rare.

Dr Tony Grewal, medical director of Londonwide LMCs, supported this view. He also pointed out that the responsibility to deregister duplicated patients lay with the NHS registration system.

‘The NHS registration system is supposed to deduct such patients from their previous practice’s list when a GMS1 (application to join a practice list) is received.,’ he said.

Dr Grewal described the figure of £6.1m in saving as ‘grotesquely disingenuous’.

He argued that a large proportion (10-50%) of patients who had been removed from GP lists reregistered with their GP. Therefore any saving made by removing the patient was ‘at most two quarters capitation fee’.

‘Removing genuine ‘ghosts’ actually allows practices to achieve higher QOF targets, and may actually increase practice income - and therefore ‘cost’ the NHS,' he said. 

Dr Nagpaul agreed that many patients removed from practice lists had in fact ended up re-registering with a GP. He said the figures ‘overlook the considerable inconvenience and distress placed on patients who have been told they have been de-registered from a practice’.

Dr Grewal also criticised the report for not taking into account the cost of the initiative itself.

‘This does not take into account the costs of this exercise – stationary, postage, practice and PCT administrative time, commission to the private providers who often carry out these initiatives,’ he said.

A recent GP investigation found that despite list cleansing exercises taking place across the country, from 2008 to 2011 overall GP list sizes in England grew by 3.2%, to 52m.

Over the same period, the overall population in England grew by 3.1%, to 52.2m.

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