GP practice shed vulnerable elderly patients to save money, NHS probe finds

BMJ 2012; 344 doi: (Published 07 June 2012) Cite this as: BMJ 2012;344:e3998
  1. Clare Dyer
  1. 1BMJ

A GP practice run by one of the most vocal supporters of the UK government’s health reforms removed older and disabled care home patients from its list for financial reasons, an NHS investigation has found.

Churchill Medical Centre in Kingston, Surrey, has been found in breach of contract by NHS South West London after delisting 48 patients at Kingston Care Home last year “predominantly for financial reasons.”

Charles Alessi, a prominent supporter of the NHS reforms and chair of the National Association of Primary Care, was senior partner at Churchill until he retired at the end of March after 26 years. In June last year, according to documents obtained by the Surrey Comet,1 the practice wrote to the care home saying it could not continue to look after the 48 patients “as a result of significant funding constraints in this financial year.”

The decision to delist the patients followed a review of PMS (personal medical services) GP contracts by NHS Kingston. Churchill told South West London primary care managers in an email that its action was taken because of “very significant cuts to our practice budget as a result of the PMS review.” It gave the care home 28 days’ notice of the delisting, saying the move was unavoidable “given the high demand for GP services from the care home” and the “decision of the primary care trust to remove funding for this specialist service.”

But while the review reduced the monthly payments under the contract, it did not amend the service requirements or reduce funding for a specific service, according to the investigation’s report, obtained under the Freedom of Information Act. The provision of services to the care home was “not a specialised service.”

The contract bans doctors from removing patients from their list on grounds of age, disability, medical condition, or need for specific treatments, and patients cannot be removed unless, during the previous 12 months, they have been given a written warning that they are at risk of removal, with reasons.

The patients, some with dementia, were distributed among six smaller practices, including a single handed practitioner. The investigation was launched after the other local GPs objected to having to take over the care of older and vulnerable patients at short notice.

Alessi did not respond to a request for comment that the BMJ asked NAPC to forward to him. Churchill Medical Centre said in a statement that it was “disappointed” with the investigation’s conclusions but was “confident lessons have been learned by all parties.”

It added: “These events took place after a protracted and polarised contractual dispute between the practice and the PCT [primary care trust] and at a time of transition . . . The practice believes these were significant contributory factors to the events as they unfolded.”

A spokesperson for NHS South West London said: “We’ve issued a formal notice to the practice which states that they can’t repeat the activities that have put them in breach of contract, and we continue to monitor the practice closely. We took action to ensure that all the affected patients from Kingston Care Home were allocated a new local GP as soon as we were alerted to this issue, to ensure that their health needs continued to be met.”

The spokesperson added that three breach notices would put the practice at risk of losing its contract.


Cite this as: BMJ 2012;344:e3998

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