Editorial Comment

“It’s not a bottomless pit”!

Steps are being taken throughout general Practice to reduce the prescribing of medications for minor ailments that can be bought at a pharmacy ‘over the counter’.

NHS England have published a leaflet for patients which explains what GPs are trying to do, encouraged by CCGs and Practice Pharmacists.

But are those promoting the non-prescribing of OTC products overstepping the mark. Should they be telling patients that they can no longer prescribe OTC products. Are they simply trying to substitute cheaper products. Are they following national NICE guidelines are using a different product which they regard as just as effective whilst still saving money. What is going to happen to small pharmacies who loose dispensing fees

In my view Practices need to be very careful about the way they introduce these changes and the words and style of language they use when doing so. Each patients case needs to be treated on its merits and reference should be made to clinical letters and recommendations made by consultants.

My understanding is that the shift to OTC products not being on prescription is not a blanket decision and GPs need to be aware of that.



Editorial Comment

Sunday Newspapers and Ghost Patients

Yet again the national Sunday press are harping on about ghost patients and the apparent cost to the NHS of over £500 million pounds per annum.

Ghost patients is a problem that NHS Managers in Primary Care have been aware of since the inception in the NHS on 5/7/1948. When I first started work in 1996 we used to send letters, known as Notices to patients when a doctor ceased to practice. If we sent out 2000 letters then at least 600 would be returned undelivered. This was a natural way of removing ‘ghost’ patients.

However in 2004, the new GP contract abandoned personal GP lists to be replaced by Practice Lists. Notices to patients ceased to be sent and medical cards ceased to be issued routinely too. Adam Smith the economist talked about war reducing the population – similarly notices to patients about Practice changes removed the, sorry, dead wood.

Nowadays there letters are only sent to patients about national screening programmes and  the dead wood effect by comparison is minimal. GP Practices are also expected to clean up their patient registration data but there are no real incentives for them to do this as they will simply loose income. Arguably it not the Practices fault that patients have moved on and not told them.

I would argue that ghost patients are a natural phenomenon of the system and it is unlikely that it will change. GP negotiations on Practice income do take into account the ghost element but the very idea of ghost patients always  captures journalists imagination.

Here are some reasons why ghosts occur :

  • Practices do not normally become aware of Patients who die abroad.
  • Patients move to a new address and for a short time may be registered twice or not at all at their new address.
  • Children may be one adopted and former registrations not traced or removed
  • Patients may change their name and still remain registered somewhere else
  • Patients may register who are refugees or asylum seekers and  remain registered although they have move on or return abroad
  • Emmigrants may remain registered but live abroad. In some cases thus may be deliver so they can return home for NHS treatment.

Looking at the figures quoted in the Sunday papers, about 6 patients out of 100 might be ghosts. This means around 55 patients per whole GP are ghosts. This amounts to around £8,350 per GP.


Editorial Comment

New Guides to Policies

I have added to the Practice Index Forum two new documents to help GP Practice Managers prepare Policies, Protocols, Procedures, Plans and Presentations that might be required by the Care Quality Commission.

It all started with the voluntary Quality Framework so the first shorter document give a summary of the topics that as a bare essential ought to be covered by a ‘document’. The second document is more detailed and attempts to provide the basis for a multitude of documents.

The link to the site, which you will need to join, membership of the Forum is free, at