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Why GPs still need funding for 'ghost patients'

I would like to introduce you to four former friends of GPs, IANI, IAGI, TANI, and TAGI.

In the not-so-distant past, the Doctors' and Dentists' Review Body (DDRB) would decide how much GPs should earn (intended average net income – IANI or target average net income - TANI) and to deliver that net income would facilitate the pricing of the various bits and pieces that GPs get paid for (intended average gross income – IAGI or target average gross income – TAGI).

Furthermore, the DDRB would check in subsequent years that IANI had been delivered and, if it had not, would make an adjustment in later years.

What happens now? The DDRB still makes its recommendation, but there is not the same assurance bthat what is intended to be delivered gets delivered.

Why the history lesson? Because I heard in the news recently that NHS England wants to remove patients who have not been seen for five years from practices' lists – aimed at stopping GPs being paid for patients no longer on their list.

All well and good, but if the DDRB is to be respected, and IANI delivered, removing patients means that they have to pay more for the patients who remain. Otherwise the DDRB’s recommendations will be undermined won’t they?

The article I read said that 5% of practice lists could be wrong. I remember in the 1990s being told by a very very senior civil servant at the DH that general practice was intentionally funded with the expectation that 105% of their lists would be paid for – to compensate GPs for all the patients they see that are not funded.

So let’s stop this cynical game, if the DDRB is to be respected tell us where the funding for these ghosts is moving to – and get that pendulum moving back without these silly stories.

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