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by Léa Legraien
13 June 2019
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The NHS anti-fraud body is to investigate general practice in a bid to crack down on apparently incorrectly claimed GP capitation fees.
NHS Counter Fraud Authority (NHS CFA) is prioritising work that will involve looking into so-called ‘ghost patients’ – people who may have died or moved away from the practice but still remain on the patient list – in a bid to challenge what it calls ‘fraud’ within general practice.
But GP bodies have pointed out that ghost patients are a result of records management issues and have said that any ‘insinuation’ of fraud on the part of GPs is ‘shocking’.
GPs have also pointed out that the current funding system for general practice accounts for practices having a number of ghost patients on their lists.
A document outlining NHS CFA’s priority areas for action in 2019/20 revealed plans to tackle potential fraud in relation to GP capitation fees.
The document said: ‘This priority area will focus on GP capitation fees. We will work with colleagues in NHS primary care to increase confidence in our assessment of the losses to fraud in this area and form a basis for fraud prevention activity.’
According to the BMA and RCGP, the authority will also investigate GPs who are claiming funding for non-existent patients.
Both organisations have expressed outrage at the NHS CFA’s new focus on general practice and have strongly denied suggestions that GPs are ‘complicit in defrauding the health service’.
RCGP chair Professor Helen Stokes-Lampard said: ‘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 a million patients a day across the country, with insufficient time, resources or workforce to do so.
‘It is, of course, important to make sure that patient lists are kept as up-to-date as possible, so that resources are used where they are most needed – and our administrative staff already spend a lot of time processing patients’ notes when we are informed that they have died, left the surgery or moved elsewhere.
‘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.’
This story was first published by our sister publication Pulse.