NHS Counter Fraud Authority to investigate 'losses to fraud' in general practice

The NHS Counter Fraud Authority has identified possible fraud around GP capitation fees among priority action areas for 2019/20 - amid concerns over record numbers of so-called 'ghost' patients.

GP capitation fees to be investigated
GP capitation fees to be investigated

A plan for 2019/20 published this week by the NHS Counter Fraud Authority (NHSCFA) lists 'fraud in relation to general practice contractors' as a priority. Checks carried out by the authority will 'focus on GP capitation fees', officials confirmed.

The NHSCFA said it would 'work with colleagues in primary care to increase confidence in our assessment of the losses to fraud in this area and form a basis for fraud prevention activity'.

Claims of potential fraud in general practice brought an angry response from the BMA's GP committee (GPC). GPC chair Dr Richard Vautrey told GPonline: 'Where this allegation of fraud has come from I don't know. It is really concerning for GPs under pressure, doing their level best to maintain services for patients, to have this kind of allegation made in public with no clear basis.'

RCGP chair Professor Helen Stokes-Lampard added: 'The insinuation that GPs - some of the most trusted professionals in society - are complicit in defrauding the health service is shocking and will be incredibly hurtful for hard-working GPs and their teams who are struggling to deliver care to more than 1m patients a day across the country, with insufficient time, resources or workforce to do so.

Patient records

'It is, of course, important to make sure that patient lists are kept as up-to-date as possible. But so-called "ghost patients" are nothing sinister - they are the result of a records management issue, not a case of surgeries deliberately profiting by keeping patients on their lists when they shouldn’t be there.'

The announcement from the NHSCFA that it will focus on GP capitation fees comes just under a year after the number of so-called ghost patients in general practice hit record levels.

Figures published by NHS Digital last year showed that the gap between the number of patients registered at GP practices and the estimated actual population of England had risen to 3.1m - up almost 1m compared with a decade earlier.

Numbers of ghost patients have risen sharply since provision of primary care support services were outsourced to private company Capita in 2015. Capita chose not to comment on the rise when this was reported last year by GPonline.

Dr Vautrey said he was aware that a 'list validation exercise' was being carried out by Capita, but added that the GPC had not been informed that checks on GP capitation fees and patient lists would be scrutinused by the NHSCFA.

Ghost patients

He added: 'I can't see how practices could inflate their lists artificially. Patients are added when they register, and removed when they move on.'

Former health minister Steve Brine said last November that Capita would ‘shortly recommence list maintenance for all practices across England' to ‘ensure that the lists of registered patients are as accurate as possible’.

The statement came in response to a question from Labour MP Roger Godsiff, who asked what action was being taken to ‘tackle the alleged practice of GP surgeries receiving payments for so-called ghost patients still registered at that GP practice but who have died or moved away’.

Overzealous list cleaning drives by primary care organisations in the past have led to legitimate patients being forced to re-register with their GPs - and the BMA has warned the process must be carried out sensitively.

List inflation

A 2005 study in the journal Family Practice warned that 'list inflation is an inevitable consequence of a capitation-based system of funding primary care'.

The study said some patients on GP lists 'probably no longer exist because of death, emigration or moving house', but added that part of the discrepancy arose from people who did exist, but who did not complete the national census - potentially because they were homeless or refugees.

The huge population shifts generated by students moving away from home to university have also been linked to driving up numbers of ghost patients.

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