UPDATE (Feb 24 2012): You can find GP surgery-level data on demographics and other contextual information on the NHS IC Indicators site.

We’ve been following developments related to GP patient lists and proposals to abolish GP boundaries for a while, and this week saw some particularly interesting developments .

Pule reported that Department of Health advisory body Primary Care Commissioning had issued guidance on “brutal new GP list cleansing targets next year”:

“[T]he guidance lists successful list-cleansing schemes and gives examples of targeted campaigns in South Gloucestershire, South West Essex and Berkshire West which resulted in the removal of 24,000 ghost patients.

“They include sending verification letters to all patients aged over 90 to 100 years and annually to all immigrants. If they do not respond, then these patients will be given a FP69 flag to inform their GP the patient will be removed from their list.

“They also say anyone who is out of the country for three months or more should be automatically struck off GP lists and that multi-occupancy dwellings should be targeted.”

Meanwhile Eastlondonlines reported on 2 of the 6 places chosen to pilot abolishing GP boundaries for a year from the beginning of April. These are:

• Tower Hamlets
• Hackney
• Westminster
• Salford
• Manchester and
• Nottingham City

We’ve got data on patient lists for the years 2008-2011 which provides a good starting point for investigating issues around patient lists.

The data needs treating with caution, because there is a lot of context to be added.

How well maintained the list is is just one factor (as illustrated by the statistics in Pulse’s report), and the health of the local population (which is influenced by various demographics) are just two aspects which can make a big difference.

So you’ll need some local knowledge and some old-fashioned shoe leather to, for example, stand outside surgeries asking patients about their experiences of trying to get appointments.

But there are plenty of leads to be followed.

For example: the accuracy of lists are a story in themselves, as doctors still reportedly receive “up to £100 for every person registered with them”. Last year four doctors were suspended over allegations that:

“They earned millions by claiming to treat more than a thousand people who were overseas or had died.

“The doctors claimed to have 8,150 patients on their books – but the General Medical Council and NHS fraud specialists have launched inquiries into claims that up to 3,000 of those were either non-existent, or genuine but with false information on their records.

“… A previous report by the Audit Commission, in 2004, warned that the NHS could be wasting £100million a year paying surgeries for patients who don’t exist.”

On the other side, the BBC reported last year on patients being wrongly deleted from lists:

“A[t] least 460,000 names have been removed from GPs lists in the capital in the past five years, a Freedom of Information (FOI) request showed […] In the east London borough of Tower Hamlets, 61% of those removed in a recent overhaul [had to re-register to keep their doctor], the FOI documents showed … Another 10,000 people had to do the same in nearby Newham in recent months.”

That research also revealed that the number of people on GP lists in London exceeded the capital’s population by over a million people, while the DoH submitted written evidence to The Commons public accounts committee that “over 2.5 million more people than the country’s estimated population were registered with England’s GPs.”

The Audit Commission then announced that it was to publish national data on patient registration inaccuracies by the end of 2011. The comments on that article from GPs highlighting inconsistent guidance and the effects of cleaning lists are worth reading.

More recently the DoH announced plans to remove incentives for general practices to have “open but full” patient lists:

“If a practice wants to close its patient list and stop accepting new patients it risks losing the right to provide additional and enhanced services. As a result some practices keep their list open but stop accepting new patients, declaring their list “open but full.””

And, for context, the One GP’s Protest blog argues that:

“The 2004 GP Contract requires GPs to register all patients in their practice area who wish to register with them […] The problem [is that] at some point you will reach capacity […]

“Our only option, within the framework of the GP contract 2004, is to apply to a panel for permission to close our list. If permission is granted, our list is then closed and we register no patients for a period of time. The inference is that if you have to close your list then you are not coping, you are a failed practice; and therefore you may be denied the option of offering certain ‘enhanced services’ to your patients (which form a significant part of practice income). As your list size declines (as people move away, or leave your list for other reasons), so your income declines.”

And then there are the individual leads that you might find in the data – for example, while sorting the data I came across one practice where the number of GPs has dropped by 50% while patient numbers continued to grow. Are they experiencing problems? How long has it taken to replace that GP – if indeed they are planning to? There are plenty of potential stories buried in each region.

Also worth noting in anticipation of any reorganisation of the NHS is how funding arrangements for GP surgeries are affected. As Pulse reports:

“The NHS Commissioning Board will have direct responsibility for ‘improving’ list cleansing and link list accuracy to CCG [Clinical Commissioning Group] authorisation.

“Once authorised, CCGs will be set budgets based on their registered patient list populations – rather than the current system of PCT funding being dictated by national population estimates. With the CCG management allowance set at £25 per head, 2.5m extra patients could see CCGs allocated an extra £62.5m in management budgets alone.

“Dr Paul Roblin, medical secretary of Berkshire, Buckinghamshire and Oxfordshire LMCs said schemes in his area – highlighted in the new guidance – meant practices were ‘suddenly losing huge chunks of patients’.”

If you need help interrogating the data for leads, just get in touch.

By the way, any suggestions on where to get data on demographics to GP surgery level or how recently lists have been cleaned would be very welcome.