Watchdog claims more accurate GP lists will save NHS £6.1m

BMJ 2012; 344 doi: (Published 23 February 2012) Cite this as: BMJ 2012;344:e1366
  1. Adrian O’Dowd
  1. 1London

A national initiative to find and remove “ghost patients” who are wrongly on GP patient lists has saved around £6.1m (€7.2m; $9.6m), claims the leading public spending watchdog.

In a new report, the Audit Commission said that around 95 000 records had been found of people who should not be on patients’ lists for various reasons such as having died or having moved to another doctor’s practice and been registered twice.

The BMA, however, said it was concerned that “over zealous” efforts to eliminate these anomalies in patients’ lists have gone too far in some places and mean some patients have been removed unfairly and mistakenly.

The commission’s report published on 23 February details its latest National Duplicate Registration Initiative (NDRI) exercise for 2009-10, which looked for anomalies in patient lists across England and Wales.

The initiative, which involves comparing GPs’ patient lists with those of other GPs and with other lists (such as Department for Work and Pensions records), to find “matches,” is designed to improve the accuracy of GP lists and was previously carried out in 1999 and 2004.

Around 95 000 records were identified and removed after the exercise and the commission calculated that because each patient’s registration is worth £64.59 a year on average to their GP, these deleted records have saved £6.1m.

The report says many areas have been thorough in following up matches, such as Manchester, where 200 patient registrations were removed after checks to confirm whether patients were still alive.

A substantial minority of other areas had not followed up matches effectively, however, which had prevented records being removed and savings made, said the commission.

Given that the commission is set to close later this year, the report recommends that the new NHS Commissioning Board runs the initiative, or an equivalent, periodically.

The commission’s work uncovered some extreme examples of patients who remained on GP lists despite having died many years before and led to the removal of 157 patients who had died before 1980, but whose GPs were still being paid for their care.

In one case, a patient who died in 1969 was only removed from a GP list in April 2011.

Andy McKeon, managing director of health at the commission, said: “The NHS and GPs generally manage patient lists well—at any one time there are some 58 million records and many movements on and off lists.

“However, the NDRI, and active follow-up locally of duplicates and other anomalies, has resulted in £6.1m annual savings. It is disappointing that some areas did not rigorously follow-up the information provided by NDRI, which would have resulted in more savings.”

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said: “We are glad that the Audit Commission recognises that the NHS and GPs generally manage patient lists well bearing in mind the number of records held and the amount of movement of patients in and out of practice areas.

“However, we have been concerned by reports from some areas of over zealous list cleaning initiatives, where patients still validly registered with a practice have been removed against theirs and their GP’s wishes, often without their knowledge.

“Often these are vulnerable patients—either elderly or non English speakers. It is important for primary care organisations and practices to work together to make sure that ghost patients are correctly identified and genuine patients are not disadvantaged.”


Cite this as: BMJ 2012;344:e1366


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