News, Culture & Society

Scandal of the 3.6million NHS ‘ghost patients’

A staggering 3.6 million patients who do not exist are registered with GPs’ surgeries, a Mail on Sunday investigation reveals today.

Despite a crackdown launched three years ago on so-called ‘ghost patients’, the numbers have risen at a rate of almost 6,000 a week.

Doctors in England receive an average of £151 a year for each patient on their books, whether they see them or not.

Doctors in England receive an average of £151 a year for each patient on their books, whether they see them or not

But millions still registered at practices across the country have either died or have moved away.

In 2015, NHS chiefs hired corporate consultancy firm Capita to tackle the problem as part of a major £330 million contract to run ‘back-office’ services.

But under Capita’s watch over the past two years, the number of ghost patients has risen by almost 20 per cent – from three million to 3.6 million.

The notional cost of the army of phantom patients is almost £550 million – enough to hire 28,000 new nurses, 10,000 new doctors, or provide free parking at every NHS hospital in England for three years.

Meg Hillier, the Labour MP for Hackney South and chairman of the Commons’ Public Accounts Committee, said: ‘We are talking about a tremendous amount of money – as much as £550 million – that is being wrongly allocated to GPs with ghost patients on their books. 

‘At a time of severe strain on NHS budgets, this could be diverted elsewhere on patients who need it.

‘The fact that the number of ghost patients keeps going up underlines the chaotic nature of back office functions within the NHS.’

Joyce Robbins, head of the campaign group Patient Concern, added: ‘Almost four million ghost patients is the size of a small country.

‘GPs are not doing enough to sort this out. It needs to be fixed.’

A spokesman for NHS England, which says it factors ghost patients into its budget allocations, said: ‘We agree that this situation is not good enough and more could be done to speed up the process of removing ghost patients.’

Our investigation discovered examples of ghost patients who have remained on GP surgery lists for years. They include:

  • A person who died in 1969, but remained on a list for 42 years;
  • A couple who emigrated to Australia in the 1960s, but were still registered with their London GP almost half a century later;
  • A Midlands practice that claimed for 24 patients at a single address – they were later found to be illegal immigrants who didn’t live there;
  • A GP in Scotland who fabricated a patient called ‘M. Mouse’ to fill up gaps in his schedule.

Whistleblower Jackie Huxter, 61, from South London, who worked as a call handler for the NHS 111 out-of-hours hotline between 2012 and 2016, told The Mail on Sunday that the problem ‘goes back decades’.

‘I had access to the NHS Spine database that would bring up patient details when they gave us their name. It was not uncommon to see people registered with two or even three GPs,’ she said.

‘You would have people calling up who were still registered with their doctor from university, their family doctor from when they were growing up, and a new one from where they live and work now.’

She added: ‘I saw it first-hand. I remember one couple, who had emigrated to Australia in the 1960s, had come back home to London to visit family when one of them fell ill.

‘They called 111 and it turned out they were still registered at their old GP practice. They couldn’t believe it.’

The ghost registers by region 

The problem is most acute in places with high numbers of students, according to official statistics. 

Cambridge has 16 per cent more people registered with GPs than its population and Oxford has 15 per cent more. 

Areas with big immigrant populations are also affected, with ten per cent more patients than people in Boston, Lincolnshire, and up to 20 per cent more in the London boroughs of Ealing, Brent and Hammersmith and Fulham.

Official figures from NHS Digital, which provides IT services to the health service, shows 59.2 million people are registered with a GP in England.

But the Office of National Statistics says the current UK population is 55.6 million, meaning there is a gap – known as ‘list inflation’ – of 3.6 million.

NHS fraud inspectors believe a small number of GPs deliberately keep names on their lists, but that most are simply failing to prioritise the issue.

Most surgeries are private businesses contracted by the NHS to provide patient care.

Patients groups and MPs last night said the worsening problem raised serious questions about the fairness with which patients were being treated.

Surgeries with ghost patients are able to divert the money they do not spend on them to their ‘real’ patients. But practices that weed out non-existent patients have no such surplus funds.

In 2011, research found a third of the ghost patients were dead.

Yet the Government’s Tell Us Once system, which is designed to allow bereaved relatives to inform all departments and agencies about a death by ringing a single number, still does not pass such information to GPs.

According to the 2011 study, around a third of ghost patients were duplications, 21 per cent were university students or graduates signed up with multiple doctors, and ten per cent were failed asylum seekers who remained on lists despite being deported.

The British Medical Association rejected suggestions of profiteering by GPs, and described Capita’s work as ‘woeful’.

Dr Richard Vautrey, chairman of the association’s GP Committee, said: ‘There are several reasons why the number of patients registered with a GP practice may not reflect official population data.

‘Most of these will be people who are in the process of moving house to different areas. Others may have recently died, or some may have left the country.

‘Others may be homeless or simply unaccounted for in Government statistics.’

He added: ‘Patients should be able to visit their GP when they need to and it is imperative they are not removed from a practice simply for being well and not recently needing an appointment.’ 

Professor Kamila Hawthorne, vice-chairman of the Royal College of GPs, said: ‘Ghost patients are the result of a records management issue from the infrastructure that manages patient registers, not a case of surgeries profiting by keeping patients on their lists when they shouldn’t be there.’

Capita, whose performance on the £330 million contract was last month described as ‘a shambles’ by the Commons’ Public Accounts Committee, declined to comment.

CASE STUDY 1: Doctor claimed for M. Mouse

A doctor cashed in by listing a ‘M. Mouse’ among hundreds of bogus patients. 

Dr Andrew Thomson deleted appointment slots from his diary and filled the gaps with ‘ghost patients’. 

But the GP, from Forfar in Tayside, avoided suspension by the General Medical Council after explaining that the scam was down to his heavy workload. 

Taking the Mickey: Dr Andrew Thomson blamed his actions on his heavy workload

Taking the Mickey: Dr Andrew Thomson blamed his actions on his heavy workload

CASE STUDY 2: The patient who had been dead for 42 years

A patient who died in 1969 stayed on a GP practice list for more than 40 years. A 2012 report by the Audit Commission, which learned the patient was only removed in April 2011, said: ‘Existing controls could be improved.’ 

In another case, a South London couple who emigrated to Australia in the 1960s discovered they were still with their practice when they visited Britain in 2014. 

And a man who emigrated to Israel in the 1990s found he was still on the books of GPs near his childhood home and at his university.

CASE STUDY 3: House with 24 people registered with GP

A practice in the Midlands had 24 ‘ghost patients’ on its list – all from the same house. 

An official report detailed how the surgery assured NHS fraudbusters that it had regularly seen each of the two dozen people. 

But an investigation concluded that ‘most of the patients registered to the address did not have appropriate status to be in the UK and were no longer resident at the address’. 

The surgery was given a slap on the wrist and its GPs given ‘guidance and training’. 

MEG HILLIER MP: Scandal that shows up a GP system in turmoil

This is a scandal that exposes the chaos behind the scenes of the privatised administration of the NHS. 

Every year hundreds of millions of pounds is being misspent on GP patients who simply do not exist.

Capita, a private company, was brought in three years ago at great expense to tackle the problem of so-called ghost patients. 

But under their watch, the number has actually risen by 600,000 to an astonishing 3.6 million.

This results in a chronic misallocation of almost £550 million every year that could – and should – be invested in patient care.

Up and down the country, GPs work tirelessly to help millions of patients and, quite rightly, family doctors raise concerns about the level of funding for the NHS.

But to retain the admiration and respect of the public, they must make sure that their own houses are in order and the number of patients on their lists is accurate.

It is wrong that some patients have remained registered with GPs for decades after they have either emigrated or died.

This has resulted in surgeries receiving vast sums for patients they never see, which is totally unacceptable.

The NHS and Capita have failed to get to grips with this situation, but GPs must also play their part in keeping the number of ghost patients to a minimum.

Deregistering patients is tricky and can potentially lead to the removal of people who are in good health and simply haven’t visited a GP for years.

But who better to be given the resources to lead the ‘ghostbusting’ exercise than the GP practices themselves?

The public also has a role by ensuring, for example, that deceased relatives have been removed from their GP surgery’s books.

This would make a massive difference, ensuring that funds are fairly distributed to all who need them.