Editorial Comment

GP Ghost Patients ‘Strike Again’!

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Dead Letters Cause A Stir 

A recent article by Daily Telegraph Health Reporter, Laura Donnelly, tells of 30,000 patients stuck off GP’s Practice List who have not responded to ‘recall’ letters sent out by NHS Agencies. This is a practice that has gone on for years probably ever since the inception of the NHS in 1948. In fact there is around a 7% discrepancy between the number of people registered and the actual population.

Anecdotal ‘ghosts’

I recall incidences in the 1960’s where an Executive Council Registrar was in the habit of studying the obituaries column in the local newspaper every Friday so that he could remove patients from doctors lists who had died. GP Practices are required to notify NHS Agencies that patients have died but in my experience rarely do. Instead they wait until the patient’s death has been registered and the NHS Central Register effectively recalls the record and removes the deceased from the doctors list. To counter that, however, there were cases of patients who had died abroad but remained registered with a GP for many years after their death. These patients have become known as ‘ghost’ patients. And it has always been a well-known fact that GPs receive payments for more patients than actually resident in their practice area although pay settlement have tried to take account of this ‘overpayment’.

Modern practices result in less checks

To add to the complication NHS Agencies no longer automatically issue medical cards to patients when they register with a doctor and also when a doctor leaves or retires the Agencies no longer write to tell patients that their doctor has left and their names have been moved to a new doctor. This system of sending medical cards or notices to patients allowed patient lists to be managed. So called ‘dead’ letters would be received for patients who had moved away. The GP Surgery would be given 6 months to find a new address, failing that the patient would quite legitimately be removed. Nowadays the NHS Agencies send recall letters to patients for Cervical Cytology and other many reasons. Where the letters are returned to the sender action it is quite legitimate to remove the patient from the doctors list after the GP practice have been given the chance to find a new address or simply confirm that the patient still lives at the given address. Where there is no ‘dead’ letter it is arguably inappropriate to remove the patient  as the patient simply has the right to ignore the letter and not to reply. Letters are sent out for breast screening and bladder screening services. Invites are sent out for retinal screening. There are a whole host of reasons. However, in the days where a ‘real’ person managed the list rather than a computer system it was perhaps not so easy just to remove patients for the sake of it unless you were in the habit of reading the obituaries column.

Robert Campbell can be contacted with comments on


Dead wood costs money – more waste!

GP List sizes are often inflated by ‘dead wood’ and it does seem quite reasonable to find ways of managing the list as the GP Practice is unlikely to do this.  If the average list size was 1,800 patients then the ‘saving’ by removing non-existent patients would be over £10,000 per annum per full time GP.

Robert Campbell is a former GP practice manager and NHS EC Deputy Registrar


Robert Campbell

By Robert Campbell<br><img src="" alt="Robert Campbell" class="avatar" width='50' height='50'/>

Started work writing medical cards in 1966 at Staffordshire Executive Council. Have worked at Inner London Executive Council, Hertfordshire Executive Council, Lambeth Southwark and Lewisham FPC, Birmingham FPC, Dudley FPC and Wakefield FPC and Family Health Services Authority. I was seconded to the NHS Appeals Unit and have worked as a full time GP practice manager since 1992 until 2010. I was also an AMSPAR trainer at Park Lane College, Leeds. Now I work as a freelance author.

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