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Practices overpaid millions for ‘ghost patients’

23 February 2012

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GPs have been overpaid £6.1m in this year alone for thousands of ‘ghost’ patients. 

The Audit Commission’s latest National Duplicate Registration Initiative (NDRI) removed 95,000 duplicate patient records across England and Wales. 

Patient registration is worth on average £64.59 to a GP. 

Andy McKeon, Managing Director of Health at the Audit Commission, criticised some GPs for not “rigorously following-up” the potential duplicate records spotted by the NDRI, which he claims would have resulted in yet more savings. 

“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,” he said. 

“However, the NDRI, and active follow-up locally of duplicates and other anomalies, has resulted in £6.1 million annual savings.” 

Patient record duplicates can occur when a patient has moved house, has died, or been removed from the country.

Not every match will necessarily result in a removal, as local areas will be asked to carry out further checks to confirm the match is the result of a duplication or other issue. 

The Audit Commission said it is “impossible” to estimate how long such ‘ghost’ patients would have remained on GP lists without the NDRI. 

In “extreme” cases, however, it could take many years. 

The NDRI 2009/10 review resulted in the removal of 157 patients who had died before 1980. 

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

Should practices shoulder the blame for the number of ‘ghost patients’ on their lists? Your comments (terms and conditions apply):

“Surely dead patients automatiacally come off through links? And how exactly are we to police this? Patients can and do move house without notifying anyone. We have notices up in the waiting rooms and in our practice leaflet requesting notification of change of address/ telephone, but if a person does not see their Dr every time they sneeze twice are we to chase them? I did not attend my own Dr for more than 25 years apart from smears and 25 years ago it was antenatal care. Do we now contact patients after a set period of non attendance and ask if they are still registered with us? Half of our patients are illiterate never mind those whose first language is not english. The local pCt did this a few years ago and the following very harsh winter when people had lots of slips and twisted ankles etc they were enraged not to be able to get Dr Appts because we had removed them. I do not suggest that GPs should be paid for ghosts but ask for reasoned and reasonable suggestions not just rhetoric as to how to solve the problem” – Name and address withheld

“At any given time a practice will have some “ghost” patients because patients very often move away without notifying the practice and it could be quite a while before the practice actually knows the patient is gone. However there are quite a few practices that are not doing anything to “de ghost” their list, whether it be on purpose or inefficiency. So in summary I think the practice should shoulder the blame for a percentage of ghosts on their list but not 100%. A lot of the problems in the NHS (“ghost” patients, DNAs) exist because patients do not take any responsiblity for their actions” – Dean Thompson, London

“I do not know how duplicated ‘ghost’ patients can remain on systems when the PCT carry out annual validations and FP69s are dealt with regularly. Having Ghost patients can be as much a curse for a GP as a blessing as money can be lost under QOF. You cannot change what you do not know, so unless practices are informed of deaths, or embarkation etc,  the records cannot be updated” – Sue Smith, Sussex

“NO!! The Health Authority would normally request a patient be deducted for various reasons. We had an occasion when we were informed that a patient had died in France, some 18 months after he was deceased and this was because of “returned mail” to the address on the Practice system. No one at the surgery had previously been informed and on this occasion the Health Authority were also unaware of his death.  Therefore, how can this be the fault of the GP or even the Health Authority. There may be Practices out their who do not deduct patients when they know they have deceased but I would have thought that most Health Authorities are made aware of a death and they then send the deduction request through. If we as a Practice are aware of a death, we send a deduction request through to the H.A. and then the patient is deducted several days later” – Karen Manciocchi, Lancashire

“If registration was tied to a national identity system – and perhaps the National Insurance number? – then it would be easy. That would get rid of duplicates, those passed away or who might have left the country? It might also help practices with the perennial and thorny issue of who from abroad gets NHS treatment – an issue which the NHS has still not tackled properly and which aggravates us taxpayers no end” – Name and address withheld

“If it can shown that a Practice deliberately kept Ghost Patients on their books, then Yes, of course. Fraud is Fraud is Fraud” – Patrick Jordan, Cheshire

“For patients who have passed away – YES. However – patients who are either British Natonals and Emigrate or Foreign Nationals who are registered but return home , who DO NOT INFORM THEIR GP – NO” – David Potton, Surrey