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Are GPs deliberately striking patients off lists to cut costs?

September 06, 1999

Very little data is available on patient removal from GP registers, and only one other study has looked into the reasons behind patients being struck off. These included rudeness, threatened violence and unspecified "psychiatric behaviour". However, it is possible that some people are actually being struck off for economic reasons. GPs currently supplement their practice income by meeting quotas for programmes such as screening and vaccination. If 90% of patients on the target list take up an offer of vaccination, the GP will get a financial reward. If only 80% do so the pay-off is less. GPs can alter these results by removing the "uncooperative" 10% from the list, thus claiming 100% take-up of the vaccination. Patients who require expensive medicines may also face removal, a factor which is particularly of concern to psychiatric patients needing drugs such as antipsychotics costing £300-500 a month.

Dr Buntwal and fellow psychiatrists at the Bethlem Royal Hospital and the Royal Free were prompted to investigate the issues involved in patient removal after finding that 30% of their patients on acute psychiatric wards had been struck off their GP's register at some point.

The team's attempts to uncover further data met enormous opposition from the Family Health Authorities (FHSAs) and the Local Medical Committee (LMC). Both the Authorities approached refused to release any information. From the raw figures on patient removal from the area's practice lists, however, it is clear that the numbers of patients being struck off tripled between 1994 and 1997. The increase is particularly noticeable in the poorest inner city areas.

The article concludes that there is a need for compulsory collection of data on the reasons why patients are taken off GP's lists. Without a proper review of the situation, there is
"a considerable danger of producing a substantial underclass - a population of people excluded from primary health care because of poor resources or personal opposition to screening programmes."

Royal Society of Medicine

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