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.