The British Medical Association (BMA) and Royal College of General Practitioners have rejected any suggestions that GPs are guilty of “wilful deception” over GP capitation fees for patients on their practice lists.
The NHS Counter Fraud Authority (NHSCFA) has this week announced its priority areas for action in 2019-20 following up on its business plan* published last month, outlining where it intends to focus attention.
Its targets for 2019-20 are to detect £22m worth of fraud, prevent £100m of fraud and recover £5m from fraud losses.
One of the priority areas will be to investigate potential fraud in relation to general practice contractors, specifically GP capitation fees.
The authority said: “We will work with colleagues in NHS primary care to increase confidence in our assessment of the losses to fraud in this area and form a basis for fraud prevention activity.”
The concern is that some GPs could be knowingly, or not, claiming for non-existent patients on their list, sometimes referred to as “ghost patients”.
A spokesperson for the NHSCFA told OnMedica.com that the organisation was investigating the data and was making no pre-judgements.
“This is an area on which the NHSCFA has limited intelligence hence the choice to focus and resource this year in filling the intelligence gap. The priority is to better understand the vulnerabilities in GP capitation and propose how these could be addressed if we find it from the data,” he said.
“Previous data analytics work identified a discrepancy between the number of individuals registered as residing in England and the number of individuals registered at GP surgeries.
“Our priority this year will be to assess whether these discrepancies remain and if they do, conduct further analysis to establish their nature and whether they were as a result of fraudulent activity or not. This will complement the work currently being undertaken by NHS England by working collaboratively with them to target specific areas of loss.”
The BMA reacted quickly with its GP committee chair Dr Richard Vautrey saying: “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 could 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.
“Data checks on practice lists are currently the responsibility of Capita, which we know has overseen a litany of failures in its running of GP back office functions. Practices, as always when this has been carried out in the past, will be doing all they can to engage with this process.”
Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “The insinuation that GPs 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.
“It is, of course, important to make sure that patient lists are kept as up-to-date as possible, so that resources are used where they are most needed and our administrative staff already spend a lot of time processing patients' notes when we are informed that they have died, left the surgery or moved elsewhere.
“But so-called ‘ghost patients’ are nothing sinister - they are 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.
“People’s circumstances, and therefore, our records, change all the time. Some practices, particularly in inner-city areas, have quite a high rate of turnover, and patients don't always tell us if they are moving on. It’s just an inevitable consequence of having a list in the first place.”
Other priority areas set for 2019-20 by the NHSCFA are:
- pharmaceutical contractor fraud
- procurement and commissioning fraud
- improving fraud outcomes in the NHS.
Susan Frith, interim chief executive officer of NHSCFA said: “By preventing fraud, by identifying it and tackling it effectively where it occurs, and by seeking to recover moneys lost to fraud we can ensure that precious NHS funds are used for their intended purpose of patient care.”
*NHS Counter Fraud Authority. Business plan 2019-20 (May 2019).