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Audit Commission finds 95,000 ghosts

1 March 2012   Rebecca Todd

More than 95,000 “ghost patients” have been removed from GP lists with the help of a new web application.

The National Duplicate Registration Initiative is an Audit Commission exercise that matches data from various sources to review GP patient lists across England and Wales and identify inaccuracies.

The newly released results of the 2009-10 audit reveal that more than 95,000 registered patients were removed from GP lists, saving primary care trusts in excess of £6.1m a year.

More than 32,000 of these patients had died, including nearly 500 people who had died more than 20 years ago.

The GP patient list data is held on the national health applications and infrastructure services system from which a snap-shot of the data was extracted in October 2009.

This data was then cross-matched between local systems and with a variety of other databases to help find duplicates or inaccuracies in the data, possibly because the patient has died or has moved house.

Where potential inaccuracies or irregularities were seen, these “matches” were passed back to NHAIS sites through the commission's secure NDRI web application.

The commission said significant improvements had been made to the method for reporting matches since the last NDRI exercise in 2004 thanks to a bespoke product developed for the job.

The new web-based application allows data matches to be hosted on a secure website and uses the same computer architecture as the Audit Commission’s National Fraud Initiative web application.

“It is password protected and encrypted to 128 bit secure sockets layer standards both for the transmission of data to the commission and disclosure of the results of data matching to participants,” the Commission told eHealth Insider.

“This system has undergone full accreditation against the government’s information assurance standards and is formally accredited to handle, store and process information up to restricted classification levels.”

The web application also includes case management tools which allow users to track the progress of their investigations and record outcomes.

The NHAIS sites review the matches and report patient list removals back to the Audit Commission through the same secure system.

The initiative also helps patients' medical records to be transferred to their new GP where previously the system was unable to link the patient's old and new GP registrations.

The medical records of nearly 30,000 patients were able to be transferred to their new GP following the 2009-10 audit.

The Commission said the government should consider strengthening patient registration procedures to prevent patient fraud and error by requiring GPs to request identification and proof of address when a new patient registers.

Also, to look at how government departments can share information about patients who have left the country. The last NDRI exercise in 2004 resulted in 185,000 patients being removed from GP lists.

 


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1 News: DH tenders for QMAS replacement | 18 October 2010
Last updated: 29 February 2012 16:19

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Effects of list inflation

KeepItSimple 111 weeks ago

But if some payments to practices are dependent on achieving activities on/for a certain %age of their total patient list, and they can't record these honestly for dead people on their list, then dead people listed make it more difficult to reach the required %ages. So inflated lists make it harder for practices to receive these payments.

Is this right??


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even more complex

Gavin Jamie 112 weeks ago

The old GMS contract had a reduction in the fees and allowances of 6% to allow for the list inflation effects.

This is now calculated individually for each PCT. The register population is scale by ONS estimates. The latest are at http://www.ic.nhs.uk/statistics-and-data-collections/population-and-geography/gp-registered-populations

So a list cleansing excercise by a PCT will directly serve to increase the amount paid per patient in that PCT.


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sorry no

Paul Cundy 112 weeks ago

Not so. The income per patient for the practice was fixed in 2003 and is uprated each year for inflation etc. It is not influenced by the total number of patinets in the PCT. The PCT's overall allocation of money is corrected each year but that allocation is for more than just primary care. Its a bit more complex.


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Chapter and verse

Gavin Jamie 112 weeks ago

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_112959.pdf

The relevant paragraphs are B17-19 of the above document.

"At each stage of the calculation, the weighted practice populations are normalised (scaled back) to the PCT normalised weighted population."

"The PCT normalised weighted population used above is the PCT’s registered population for the current quarter multiplied by its latest Quarterly PCT Normalising Index."

The payment per adjusted patient thus varies from PCT to PCT


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Waving away the smoke - not putting out the fire

mrtablet 112 weeks ago

Perhaps someone should look into the duplication of patient registration >databases< in the NHS.

e.g. NPfIT's Personal Demographics Service exists in parallel with NHAIS

http://www.lasca.nhs.uk/images/FHS/Graham%20Ambrose%20-%20Slides.pdf


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False economy

Paul Cundy 112 weeks ago

Primary care is funded by an allocation of X per patient listed. That money then makes its way down thae chain to each practice. The practice then deploys the money it gets to treat the patients THAT IT LOOKS AFTER.

The X has been established over many years historic budget setting.

The national registered list has allways been inflated. Ther are reasons why it always will be. List cleansing has been going on for decades.

Removing "ghost" patients from this payment system system simply results in a budget cut for teh practice. Paying any practice less because its list has been cleansed does not result in a reduction in demand being made of teh practice by its patients.

If the lists were perfectly clean then the end result would have to be a re-basing of the input X per patient.

I'm not justifying infklated list just explaining that this is a more complex situation than "GPs being paid for patients they don't treat" (which of course it is not).

Paul Cundy


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A missing piece in the argument

Nick Tordoff 112 weeks ago

Where PCTs have failed to run decent list cleansing systems their funding will also be inflated to the disadvantage of those PCTs who have done it properly.

GPs who fail to notice that one of their patients has been dead for 20 years will disadvantage those GPs in their area who manage their list properly.


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