It’s worth noting that GP practices has a huge incentive to keep you on their list, and to kick up a stink whenever anyone tried to remove you. GPs contracts are largely paid on a per patient basis.

Obviously this seems very worrying, but what are the actual implications of being removed from the list? Are you no longer entitled to see a GP? Can you ever get back on the list? If so how long will it take and what kinds of bureaucratic hoops will you have to jump through?

I have read this and the original article and I am not sure how bad the implications are. Here are the questions I believe the article raises but does not answer, which leave me worried but ignorant.

1) Which services and treatments do I lose by being removed from the list?
2) Can I get back on the list once removed?
3) How difficult is it for someone to get back on the list once removed? e.g. what are the procedures for getting back on the list

The article raises a putative problem but it’s not clear that it is a problem at all. If the answer the 1 is none, then there is no problem. If the answer to 1 is at least some services and/or treatments then there seems to be a real problem. Answers to questions 2 and 3 will indicate the size of the problem.

Having said that if it is even a small problem and if the saving is only £268,000 as stated in the Pulse Magazine article then it seems to be a very bad decision.

@ 2 Red

One possible problem is that people with semi-urgent problems may visit A&E instead of a doctors’ surgery if they think that they’ll be delayed getting an appointment at the latter. Hell, I’ve done that even though I’m registered at a surgery, because getting an appointment at my doctors’ relies on you being able to navigate their Kafkaesque booking policy.

I can’t understand how this idea is meant to save money, unless they actually want to discourage the sick from seeking treatment (and no, that’s not what I think they’re doing). How does it cost money to keep someone’s name and address on a list somewhere? Sure, if a patient’s gone AWOL the practice shouldn’t waste time sending them letters, and it should stock up on flu jabs etc based on its real-terms patient base instead of the total number of people on its books. But just keeping someone registered should be essentially free. Don’t see the point in this.

Have a read of this blog by Jonathon Tomlinson (you’ll hear more from him next week at the BMA’s special representative meeting) to learn why it is important that there are patients registered with GPs who do not use the GP services.

“Young, mobile patients who consult infrequently generate income for GP’s because the fee we earn from registering them exceeds the cost of care. It is because of our patients who need little care that we can look after patients who need a lot of care. If young patients who want a quick, convenient service choose to register with a Virgin or Sainsubury’s surgery because it’s quick and convenient, then established practices will be left with increasingly complex and costly patients and they will soon be bankrupt.

“Suburban practices will be particularly worried about the changes because their commuter patients will register in the cities, leaving them with the elderly, housebound, the unemployed, young mums and children. All of whom consult more and have greater health needs that average.”

For the sake of those people who need the healthcare, make sure that you remain registered with your *local* GP.

I also received the letter (without any previous letters) – and after confirming my phone number with them and being a bit puzzled, did some digging.

What I have been told – could be wrong – is that this is more of a way of cleaning up the paperwork than an attempt to disbar people from healthcare.

Most doctors have a large number of people on their records who have since moved away and not re-registered elsewhere. As GPs can only take on x number of patients, having these “zombie patients” on their books means local residents are often being told the GP surgery cannot take on any more patients because they are full.

While I think the tone of the letters is rather bad, it certainly does provoke a reaction from people who are still living in the area to go in and get their details updated.

So, a scheme that ultimately makes it easier for local residents to get to see a local GP is being condemned?

A report by the London Medical Committee (PDF) has found that practices in Brent may lose up to 40% of their patients and has warned that some surgeries may have to close as a result.

May I suggest that should read: “A report by the London Medical Committee (PDF) has found that one or two practices in Brent may lose up to 40% of the patient names on the current list but it is unlikely that some surgeries may have to close as a result.”

I’ve been helped by a number of the comments on here, so thanks everyone.

It seems to me that the government saves money because it distributes funding on the basis of the number of people on your books. By removing many people from the books who don’t ‘tend’ to use the services and treatments provided by GPs the government can maintain it’s funding per head system, and even the amounts, and save money. Prima facie this seems a good idea since GPs are getting money for people who they don’t treat. However, to make that argument you would have to assume that the per head was exactly correct. This seems a dubious assumption.

The drawback, then, seems to be that GPs surgery’s will have smaller budgets overall to treat the patients which take up much of it’s budget because, as Richard Blogger points out, the young and health are subsidizing (I hate that word) the treatment of the elderly.

It really is starting to sound like a private system now, and I hate it. I thought NHS was supposed to be ring fenced?

To return to my questions it seems like it is not a problem to remain on the list or to re-register, though it depends on whether there is to be a cap on numbers and how difficult the forms etc. are.

It seems that it is just a tactic to reduce funding for GP’s surgeries. Is it the case that GPs surgeries have more than they need to treat everyone who comes to them for treatment? Shouldn’t we have an answer to that question before we start looking to save. I am now very worried that GPs will be less able to support the most vulnerable as a result of these changes.

Surely there are better ways of saving this amount of money? I believe it is the task of the left to identify equivalent savings/revenue from other sources, and I believe that so far the opposition are not doing a very good job of it. There must be thousands of examples, the most obvious being the high speed rail link for £32bn (see fact checker on Channel 4 website).

@ Red

“It seems to me that the government saves money because it distributes funding on the basis of the number of people on your books.”

Ah. Everything suddenly looks clearer.

GPs are paid a capitation fee. An annual fee for everyone on their books.

So it’s in the GPs interests to have people who have moved, died, emigrated, whatever, on their books as they get paid.

It is obviously in the taxpayers’ interest (ie, our interest) that people who have moved, died, emigrated, are no longer on GP lists so that we don’t have to pay for the people who have moved, died, emigrated.

Taking these people off GPs books is a saving of taxpayers’ money with absolutely no cost to frontline services at all. You should all be applauding this, not whining.

@Tim

“It is obviously in the taxpayers’ interest (ie, our interest) that people who have moved, died, emigrated, are no longer on GP lists so that we don’t have to pay for the people who have moved, died, emigrated.

Taking these people off GPs books is a saving of taxpayers’ money with absolutely no cost to frontline services at all. You should all be applauding this, not whining.”

It is only at no cost to frontline services if the only money being spent on frontline services comes from those who are actually on the books. It seems perfectly possible that the ‘surplus’ which GPs receive for patients they don’t treat is required in order to treat the patients they do have because they are under-funded. As such removing the ‘surplus’ funding would mean that frontline services suffer. Presumably GPs do spend this money, and obviously they don’t spend it on those who have emigrated or died, so it must be going on the sick or frontline.

The question of whether GPs, and other health services for that matter, have a large enough budget to do what they must, this question hasn’t been answered. It seems to me at least that putting a figure on a person’s head which is supposed to cover their yearly cost to the NHS is not a good way of doing this, especially if the figure is (roughly) the same for everyone.

Furthermore, whether such cuts are in the taxpayers’ interest is a complex empirical question. I like to make one suggestion which supports the case that it is in the taxpayers’ interests to allow, under the current funding system, that GPs keep phantom patients.
It seems plausible that better-funded GPs surgeries are more likely to encourage and make it easy for local people to attend regularly may prevent much more expensive treatments from being needed in the future.Claiming for phantom patients makes them better funded and so more likely to have preventative benefits for the tax payer. Therefore, it is in our interests.

@4 So instead of re-jigging the system to take these high cost patients into account we should all put up with considerable inconvenience and take unnecessary time off work to see our local GP? Why in the seven lower hells would we want to do it that way?

@Falco

You are right that “re-jigging the system to take these high cost patients into account” would be by far the best option, but that is not what is on offer. Since the option (as Richard implies) is to register with GP or else have under-funded GP services the best option is to register so that GPs can afford to treat those who need it most.

Of course, a crucial premise in that argument is that GPs are no over-funded, and this, as I have stressed, has not been established.

@ 9 Tim

“Taking these people off GPs books is a saving of taxpayers’ money with absolutely no cost to frontline services at all. You should all be applauding this, not whining.”

There’s something in what you say, but there are costs other than financial ones. Such as when someone who needs treatment finds they can’t get an appointment because they’ve been knocked off the list.

I think it would be more sensible to keep them on the books, but discount anyone who hasn’t been in contact with the surgery over a given period when it comes to allocating resources.

I don’t see the problem. If you don’t go to the doctors for a while, you get two letters and if you ignore them you are taken off a list. Without the letters I might object but for gods sake.

Some people will complain about anything.

@ 14 Cahal

“I don’t see the problem. If you don’t go to the doctors for a while, you get two letters and if you ignore them you are taken off a list. Without the letters I might object but for gods sake.”

Thing is, people throw out unsolicited mail, and move house without telling their doctor. I guess that’s their fault, but I think it’s a bit much to cut people off as a result. Especially as we’re not all shining examples of mental good health – some people forget things like that for understandable medical reasons.

Do you have to physically see your GP?

I’m on a repeat prescription. The fact that I still collect this monthly – and pay – should be proof enough that I’m still living, still in the area, and still mental.

@16 – The fact that you have to even bother going to get a repeat prescription is a waste of time for all concerned.

I have asthma, I always will, and need a prescription every month. It is a waste of time for me to get it, I should be able to just buy it from a shop like I would toothpaste, with perhaps an annual check up. It would also be far safer, as if I lose my inhaler I can just replace it without needing to wait 2 days for a repeat.

Since the NHS pays GPs according to the number of patients on their lists, list-cleansing (which is standard practice in many parts of the private sector where you get paid for work done rather than the number of people on a list) will reduce overpayment of some GPs for work they do not do. This will enable the NHS to spend money where it is needed. Sounds like a good idea – but of course GPs who have padded their lists with names of people who are no longer there are screaming because they will suffer a pay cut to a mere £80,000 p.a.
@ Chaise It is not necessary to be on a particular’s surgery’s list to get an appointment: when my son was at university he was required to register with one of their approved list of doctors but was able to use our local surgery during vacations. So I suspect Dr Helen Clark is scare-mongering

‘@16 – The fact that you have to even bother going to get a repeat prescription is a waste of time for all concerned.’

For a moment I thought you meant because the medication obviously isn’t working

@ 18 John77

“Chaise It is not necessary to be on a particular’s surgery’s list to get an appointment: when my son was at university he was required to register with one of their approved list of doctors but was able to use our local surgery during vacations. ”

I did the same thing when at uni, but I had to get hold of a form from my term-time surgery so that the one near my parents’ place would take me on. I don’t know if they would actually have refused to see me without a form (I doubt it tbh), but it could have taken longer to get an appointment, and apparently they wouldn’t have been able to get at my medical records. Obviously you wouldn’t have a form prepared if you thought you were still registered at your local GPs’ office!

I don’t know whether your son needed paperwork or not, but even if he did, all that shows us is that some surgeries are easier to get registered with than others. On the other hand, probably some scare-mongering going on too.

@ 17 Planeshift

“I have asthma, I always will, and need a prescription every month. It is a waste of time for me to get it, I should be able to just buy it from a shop like I would toothpaste, with perhaps an annual check up. It would also be far safer, as if I lose my inhaler I can just replace it without needing to wait 2 days for a repeat.”

Ventalin, or one of the snazzy new versions of it? I agree, there’s no logic to it not being available over the counter.

Till recently, I had to have an annual check-up (made difficult by my surgery’s aforementioned Kafkaesque appointment-booking system) to get the ventalin and other products I have for my hay fever. You know, in case I was faking it so I could score me some antihystamines…

Not being registered with a doctor causes more time and papework, either people will visit A & E, for non-emergency treatment, as another poster has mentioned, or a doctor will be called-out from a surgery which has no record of the person.
Although I doubt if many people will be dropped from their doctor’s register for all the reasons cited above.

@ Chaise
I don’t know whether my son needed a form from his term-time surgery but he didn’t have one the first time – went round not knowing whether or not they would see him and came back via the pharmacist where he presented the prescription. I think we are fortunate to be registered with a practice that actively tries to help.

@ 23

” I think we are fortunate to be registered with a practice that actively tries to help.”

Exactly – you’d have had more trouble if you’d come up against a jobsworth or, more likely, a surgery that just had an inflexible computer system.

I remember reading once about a surgery that tricked its system into thinking a park bench was a house, because they wanted to help some vagrants but couldn’t get them on the system without an address. Good for them, but why on Earth would the system be that unforgiving in the first place?

17. If you were in Scotland, as I understand it, you would be able to call at your local pharmacy, where, after a few basic questions the pharmacist would be able to supply you.

As a fellow asthmatic of 65 years standing I’m with you. I wish the Scots system could be introduced in England

i’m not a fan of lansley at all or the tories but i saw this stuff today that had me bemused…

SIR – Today, smokers are asked to observe No Smoking Day.

They may also finally get to hear Government proposals that could ban the display of tobacco products in retail outlets, and only allow tobacco to be sold in plain, state-prescribed packaging.

If the Coalition is committed to defeating the enemies of enterprise, as David Cameron, the Prime Minister, claims, a good start would be to call a halt to the relentless campaign to “denormalise” smoking through an endless barrage of new controls, directives and diktats.

Mr Cameron claimed last weekend that he would wage war on bureaucrats who concoct ridiculous rules and regulations.

Banning the branding of tobacco products or making cigarettes an under-the-counter product would be yet another victory for these very bureaucrats.

Life would become more difficult for newsagents and tobacconists and easier for the providers of illicit tobacco to pass off their wares as legitimate. We cannot yet be sure about whether the Prime Minister’s commitment to combating regulation and red tape is truly serious.

If his Government now unveils proposals to further restrict the sale and purchase of tobacco, it will be a clear sign that his new commitment to enterprise is little more than political rhetoric.

Patrick Basham (Director, Democracy Institute)
Dr Eamonn Butler (Director, Adam Smith Institute)
Donna Edmunds (Director of Research, Progressive Vision)
Dr Helen Evans (Director, Nurses for Reform)
Dr Tim Evans (Chairman, Economic Policy Centre)
Daniel Hamilton (Director, Big Brother Watch)
Angela Harbutt (Executive Director, Liberal Vision)
Tim Knox (Acting Director, Centre for Policy Studies)
Mark (Littlewood Director General, Institute of Economic Affairs)
Matthew Sinclair (Director, The TaxPayers’ Alliance)
Simon Richards (Director, The Freedom Association)

A spokesman for Big Brother Watch, a civil liberties campaign group, said: “Not content with increasing taxes on tobacco to sky-high levels, it appears the Health Secretary now wants to go one step further and impose plain packaging on tobacco products.

“This would be just the latest move by the Government to demonise smokers, a group of people who voluntarily choose to consume a perfectly legal product.

“The Government likes to talk about freedom – how about respecting the rights of smokers? Under Andrew Lansley, the nanny state is alive and well.”

isnt there a conflict with smoking / health or are these f*wits to stupid not to see it? btw i see our old friend helen evans from Nurses For Reform is on the list..bang goes her credibility

so what side is lansley on? health or enterprise..i feel we ought to know..

As a lifelong non-smoker, I can do without the likes of ASH, whose abuse of statistics and outright lies are offensive to anyone honest who has ever studied statistics, and bobchewy, who is hijacking a separate debate.
Smoking does increase the likelihood – *not* certainty – of suffering various illnesses but so does obesity, which is (i) a common result of giving up smoking and (ii) now a greater cause of premature death than smoking among the under-40s.
I used to advise youngsters not to take up smoking on health grounds and because it reduced their sporting performance but now I am forced to say “No, giving up smoking won’t reduce your chances of dying from cancer by 90% overnight” when people regurgitate the trash spouted by ASH. It will help but it’s not a magic wand.
Enterprise is not one of Andrew Lansley’s responsibilities, but truth is. I hope that he will encourage people to avoid/give up smoking without demonising a legal activity that causes no verifiable harm to third parties (unlike cannabis and other drugs).
[I have never seen any statistical proof of the existence of passive smoking - a non-smoking friend, who was also an actuary and understood the numbers, used to file "Passive smoking" under "P for Phlostigon"]
“isnt there a conflict with smoking / health or are these f*wits to stupid not to see it?” Of course there is – does bobchewy want to close down Macdonalds and its competitors, every ice-cream parlour, every pub, every fish and chip shop unless it switches over to grilled fish and boiled potatoes, any baker who dares to sell cake or eclairs, ban the sale of sausage rolls and pork pies, etc etc? The letter was about freedom or is bobchewy too (spelled correctly) stupid not to see it?
Can we get back to the topic?

@27 wha hey….wait a minute first i am not spamming or hijacking any debate here..i just saw this odd thing on a site…connected with health…what struck me about it was a certain name ie helen evans who runs the neoliberal Nurses For Reform anti NHS crap…what struck em as odd was that this pro tobacco agenda of which she seems to support despite calling herself a ‘nurse’ was that they were miffed at health secretary lansley for not supporting it..which is pretty stupid idea since he is supposed to be to do with dept of health and everyone sane knows the effect on health by smoking ..so thats why i couldnt understand why these nutters were so pissed off with him (apart from the fact that hes trying to dismantle the NHS)..so before you have a rant at me i suggest you re read my post and see the absurdity of it all and the cats of characters involved eg ms evans…jeez and al i was trying to do was help out…blimey..

the topic seems to have dried up some days ago…i thought the thread had stopped….whats with you mr angry?

@ bobchewy
I am not “mr angry” but I *am* objecting because you *are* hijacking a site to spew out your rant.The topic of this site is the cleansing of NHS lists of names of patients who are no longer there and the risks of deleting real patients from a GP’s list. There is no difference between smokers and non-smokers in this debate!
If *you* read *my* post you might possibly observe that I am a non-smoker who wants to discourage smoking, whereas your later post implies that you are principally interested in attacking Helen Evans.
If you read the letter than you quote you might, or might not, notice that the signatories do *not* discuss the health effects of smoking and Mr Lansley is not mentioned in the letter.
You are entitled to your freedom to rant but when you when you attack Andrew Lansley for something he hasn’t done yet and call people “f*wits” when they discuss individual rights to indulge in practices that are, probably, less harmful than eating at MacDonalds every day, you must expect that those of us who care about truth, let alone freedom, may want to use *our* freedom to debunk your rants.
“everyone sane knows the effect on health by smoking” NO – some of us do, others like you rant on the basis of their invincible ignorance.
People like you make it a damn sight harder to explain the real facts about the disbenefit of smoking, as I pointed out in my previous post, so I should be entitled to be angry, although in fact I was merely being dismissive. It seems that you are unable to accept criticism without ad hominem attacks on your critic, a trait that would be more appropriate to “master angry”

@30 what rant?? i’m not ranting..the only rant is coming from you…i’m not attacking ms evans..though i cant see why i shouldnt since her half baked ideas i’ve read in other artocles where she asserts NHS is a communist plot..is worth a kick. and excuse me but it seems that big brother watch wants to have a go at the health sec for taking up the cause of fag smokers when his job is health sec…and ive not taken or hijacked a thread which seemed to be dead when i posted to it as i couldnt find a suitable thread connected with health issues…anyway i cant be arsed as this sounds like two ppl arguing over parking space after the party ended and left days ago..begging the bloody question why dont you comment on earlier parts of the thread..why pick on me? hooray for you for your non smoking stance…you really need a lie down….

btw just in case ‘the having a go at health sec’ is a quote from this lunatic big brother site..not me..

@ bobchewy
Not hijacking?
“as i couldnt find a suitable thread connected with health issues”
“i’m not attacking ms evans” “these f*wits” “helen evans from Nurses For Reform is on the list..bang goes her credibility”
“so what side is lansley on? health or enterprise..i feel we ought to know..” “btw just in case ‘the having a go at health sec’ is a quote from this lunatic big brother site..not me.”
I’m descending into plagiarism since it’s such a lovely (albeit irrelevant) quote “just how stupid do you think I am?2

i’m going to write a full stop . now lets how how we can debate as many interpretations in that as possible…