Wigan GP surgeries' ghost patients

Dr Tim Dalton
Dr Tim Dalton

Doctors’ surgeries in Wigan have thousands of patients on their registers who may be dead or have left the area, according to analysis of NHS figures.

So-called ghost patients are a serious problem for the NHS, as the money allocated to surgeries is linked to the number of patients on their books.

Other news: Wigan yob's attack leads to 999 violent crimes clampdown

The most recent estimate for the population of Wigan Borough CCG, which is in charge of commissioning healthcare services in the area, is 323,060 - but there were 328,761 patients registered with GP surgeries in the area last month.

This means up to 5,700 of these could be ghost patients, or 1.7 per cent of all those registered.

The Office for National Statistics last updated its population estimates in mid 2016, so it is possible that population growth may account for some ghost patients.

But analysis of ONS figures shows that, between 2011 and 2016, the population grew by 0.3 per cent on average each year, so it is unlikely this accounts for all extra patients.

Local health chiefs today admitted there was a problem when people didn’t update practices and so created “ghost” patients, but said that to claim there were 5,000 of them in the borough because there are more patients than residents was “simplistic and unhelpful.”

GP surgeries receive funding based on the number of people they have registered, which is then weighted to take into account key patient demographics like gender, age and disability.

Wigan Borough CCG was allocated £47.1m from the NHS based on the number of registered patients in the 2016-2017 financial year. NHS figures show this was an average amount per patient of £144.86.

The funding formula is revised annually but based on these figures, the CCG would receive around £47.62m for patients on the register in the coming financial year. But if the population figure was used instead of the patient register it would be £46.8 million.

This means as much as £826,000 would be allocated to ghost patients.

The health service has found no evidence that doctors are deliberately inflating patient numbers, and blames poor record keeping for the number of ghost patients.

As far back as 2012, the Audit Commission identified this problem with GPs’ record-keeping and removed 95,000 patients from surgeries’ lists.

But the problem appears to be getting worse. Three years ago, there were up to 459 ghost patients in Wigan, compared to 5,701 in the latest figures.

There will be more ghost patients in areas with high student populations, according to research published by the House of Commons Library. It’s also possible that in some places, particularly those with high numbers of short term migrants, the Office for National Statistics may have underestimated the resident population.

The NHS has been concerned about ghost patients for some time, and in 2016, it hired private company Capita to clear non-existent patients from GPs’ registers. The firm has written to patients who have not contacted their registered practice within five years, as this could be an indicator that the patient has moved away.

NHS England says it factors ghost patients into its budget allocations. A spokesman said: “GP practices work hard to keep their registered patient lists as accurate as possible and NHS England is working with Capita and GP surgeries to transform this process, make it digital and any savings identified will be ploughed back into the NHS.”

Dr Tim Dalton, a local GP and chair of NHS Wigan Borough CCG, said: “Making sure practices lists of thousands of patients are always 100 per cent up-to-date is obviously a challenge and it does rely on people updating their practice, so it is likely that there are a small number of ‘ghost’ patients.

“However, to say that there are 5000 ‘ghost’ patients registered at Wigan borough practices because we have more patients than residents is simplistic and unhelpful.

“The number of estimated residents in an area and the number of patients actually registered at practices in the area will never match. One major reason is because people register with the nearest practice they like, whether that is in their local authority boundary or not.

“We have quite a few really great practices on the outskirts of the borough boundaries and they have patients registered from the other areas, so for example practices in Golborne might have patients from Warrington, and practices in Orrell may have patients from West Lancashire or St Helens.”