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List cleaning costs time and money

Inappropriate efforts to cut 'ghosts' from practice lists have an effect on GPs and patients.

PCT list-cleaning drives continue to cause huge problems for some practices, but official data suggest such efforts are largely a waste of time and money, GP leaders say.

This month, the NHS Information Centre released data on patients registered at GP practices in England in 2011. The figures show that most PCTs continue to have fewer patients registered at practices than living in their geographical area.

Since 2008, despite intensive list-cleaning efforts aimed at cutting 'ghost' patients, there has been a small increase in the proportion of patients registered with GPs.

From 2008 to 2011, overall GP list sizes in England grew by 3.2%, to 52m. Over the same period, the overall population in England grew by 3.1%, to 52.2m.

Cuts in practice budgets
But these national figures mask the fact that practices in some areas have seen thousands of patients wiped off their lists, cutting thousands of pounds from practice budgets.

Practices in Brent Teaching PCT lost 14,590 registered patients from 2008 to 2011, representing 5.5% of the total number of patients originally registered with practices.

Over the same period, GPs in Newham PCT lost 9,783 patients and those in Hammersmith and Fulham PCT lost 4,508 patients.

Dr Tony Grewal, medical director of Londonwide LMCs, says list cleaning has been a huge problem in London. 'Entire boroughs were targeted and patients were removed who were genuine,' he says.

'Practices were losing up to 30% of their patient lists to then discover at least 50% of patients removed were genuine.'

Dr Grewal said: 'Apart from a loss to gross practice income they were also a waste of practice time.'

To stop PCTs from targeting any patients who had been seen by a practice in the past 15 months, NHS London's 'Once for London' set of principles for list maintenance has now been drawn up.

Dr Grewal says he hopes the principles will prevent 'one-off hits on practices'.

Practices in other cities have also suffered in the wake of PCT list-cleaning initiatives.

Dr Robert Morley, executive secretary of Birmingham LMC, says list cleaning has affected practices across Birmingham.

Cuts to patient lists are forcing GPs to work just as hard for less money, he said.

'List size may fall but workload doesn't fall, it's effectively a decrease in funding but not a decrease in workload.'

Dr Morley said: 'It has caused a lot of frustration as well as additional workload for practices. My concern is that inner city practices have lost an awful lot of money.'

Dr Morley warned that list cleaning could also affect doctor-patient relationships, with patients wanting to know why they were removed from a list without being told.

Dr Grewal says list cleaning can prevent patients from accessing the health services they need.

Vulnerable groups, such as those with mental health problems or who do not speak English, would be particularly affected, he said.

Inappropriate use
GPC deputy chairman Dr Richard Vautrey says PCTs have always monitored practice lists, and such exercises are not a problem if they are carried out in an appropriate manner.

'However in the past few months in certain areas, whole sections of patients have been removed.'

Dr Vautrey points out that the national figures show that many list-cleaning exercises have been a waste of time, creating unnecessary work for GPs.

'It just shows they are not good value for money,' he says. 'They are inappropriate and wasteful. In reality it is an awful lot of work for the practices involved.'

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