GPs Shocked by Fraud Investigation Into 'Ghost Patients'

Peter Russell

June 12, 2019

Doctors' leaders said they were shocked by reports that the NHS Counter Fraud Authority (NHSCFA) had launched an investigation into so-called 'ghost patients' on GP lists.

It focuses on concerns that some GPs could be knowingly, or not, claiming capitation fees for non-existent patients on their list.

The Authority confirmed to Medscape News UK that it was investigating "a discrepancy between the number of individuals registered as residing in England [and] the number registered at GP surgeries".

The Royal College of General Practitioners (RCGP) said any inconsistencies were likely to be a result of record management issues, such as when patients move home without informing the surgery.

Priority Areas for Fraud Action

Earlier this week, the NHSCFA identified four priority areas for action during 2019-20 based on latest intelligence on fraud risks facing the NHS. These were:

  • Pharmaceutical contractor fraud

  • Procurement and commissioning fraud

  • Fraud in relation to general practice contractors

  • Improving fraud outcomes in the NHS

Figures showed that in 2017 to 2018, the NHS lost £1.27 billion to fraud.

The Authority's targets for the current financial year were to detect £22 million worth of fraud, prevent £100 million of fraud, and recover £5 million from fraud losses.

An NHSCFA spokesperson said the focus on GP capitation fees was "an area on which the NHSCFA has limited intelligence, hence the choice to focus some resource this year in filling the intelligence gap".

The spokesperson continued: "The priority is to better understand the vulnerabilities there may be in GP capitation and propose how these can be addressed."

The NHSCFA said it intended to assess whether previously identified discrepancies remained and, if they did, establish whether or not fraud was taking place.

'Nothing Sinister'

Prof Helen Stokes-Lampard, chair of the RCGP, commented: "The insinuation that GPs – some of the most trusted professionals in society – are complicit in defrauding the health service is shocking and will be incredibly hurtful for hard-working GPs and their teams who are struggling to deliver care to more than a million patients a day across the country, with insufficient time, resources or workforce to do so."

The RCGP said so-called 'ghost patients' were "nothing sinister" but were "the result of a records management issue, not a case of surgeries deliberately profiting by keeping patients on their lists when they shouldn't be there".

Prof Stokes-Lampard described the exercise as "demoralising for GPs and a questionable use of scant NHS resources".

Dr Richard Vautrey, GP committee chair at the British Medical Association, said: "There are many reasons why the number of patients registered with a GP practice may not reflect official population data, and we should therefore be wary about the term 'ghost patients' which will be offensive to the many patients who could be contacted as part of this process but who have very real healthcare needs.

"You can only be registered with one GP at a time, and while some of these will be people that have recently died, or left the country, others may be homeless or simply unaccounted for in government statistics, and we would be concerned at any suggestion that any discrepancies are down to wilful deception by hardworking GPs."

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