people
case study P
atients are a precious commodity for a practice. Under the GMS contract, around 50% of the average practice’s income is paid under the global sum, which is based on a practice’s list size. For general practices struggling in an unkind financial climate, every little truly does help, so a PCT announcing a list-cleansing exercise for its practices can be the cause of many sleepless nights for managers, who have to think about payroll, general upkeep and the many costs and outgoings demanded of the modern general practice. Cleansing exercises are becoming increasingly commonplace as pressures on the health service demand £20bn in savings by 2014 and thus a constituent of most Quality, Innovation, Productivity and Prevention (QIPP) plans. As a result, primary care organisations removed over 100,000 patients from practice lists in 2011, as some 36% of them currently run list-cleansing schemes, while over half of the PCOs said they planned to run one over the last year.
The PCO list cleansing exercise helps
ensure that GP’s patient lists are accurate with the aim to remove invalid patient records such as those for “ghost” patients, “gone-aways”, deceased patients, and duplicates. According to Primary Care Commissioning, it is essential for increasing fairness in general practice, because it makes sure GPs with accurate lists do not “lose out” to those with out-of-date over-stated lists, therefore everyone receives their fair share of the funding. With thousands of GP practices to get
through, the PCO can sometimes make mistakes, and in these cases, the practice manager finds themselves fighting for their funding. This nightmare became a reality for Catharine Lau, practice manager of the East Finchley Medical Centre a medium- sized GP surgery in north London when NHS Barnet flagged just short of 800 of her 5,800 patients with an FP69 code, which advises surgeries when the PCT thinks the patient has moved house and should no longer be a patient there.
THE WAY FP69 FLAGS WORK The PCO undertakes an active list cleansing initiative by sending letters to people on the practice’s list, usually addressed to “the occupier” and normally in English, asking them to send a reply card confirming they still live at the address. If the letter is not replied to using the provided reply card, it
will trigger an FP69 on the practice’s list. In most cases, FP69s appear
automatically as an incoming message in a practice’s system. Upon receipt of an FP69 notification on a person’s name, a practice is given six months to verify that a patient remains on the practice list and prove it to the PCO. For it to work, patients must be bothered
to reply to the letter (“The majority of people I spoke to said they never received the letter,” says Lau) and they have to have had the inclination to visit their GP in the last 24 months, which for some people only means when they’re ill. There are also a number of other reasons Lau cites for people not returning the form: “You have people who are in hospital at the time; you have people who are mentally ill or not aware of what is going on; you have people with learning disabilities who did not necessarily comprehend the letter and didn’t think it was important to reply.”
A LIST-CLEANSING ‘NIGHTMARE’ Lau’s experience of list-cleansing was particularly traumatic. Brent PCT said it sent a letter in January of last year warning its practices that it would be sending a list of FP69-ed patients in June, but Lau received neither letter nor list, instead, she was lucky that one of her team noticed the flagged patients on the system – however, this wasn’t until October and the lists had to be investigated by the end of the year. So instead of the usual year’s preparation, Lau had three months – not forgetting any holidays she had planned around Christmas. “It was a nightmare from the time I noticed the 800 FP69s on the system,” she remembers. Going through all those FP69s is no easy task for any practice, but it’s especially challenging for a smaller practice in London with an admin team of seven. In order to keep her practice’s funding, Lau had little choice but to go through the list herself. She went through each FP69, noting the last time they had a consultation, which had to have been within the last two years to qualify. Working lunchtimes and extra hours in the evening, this took Lau two weeks and she found she could justify keeping around 600 of the 800. But this wasn’t it. After logging the flagged
patients’ last consultations on the system, Lau noticed that they had not yet been picked up by the PCT. “A couple of weeks
fast facts
Practice The East Finchley Medical Centre PCT NHS North Central London Patients 5,600 CCG Barnet Clinical Commissioning Group Partners Three GPs Clinical staff One full-time practice nurse Support staff Seven Practice Manager Catherine Lau Time in role Five years Background Catherine Lau has been working for the NHS since 1996, when she left her career in hotel marketing and sales. She became a practice manager in 2004, after which she changed roles to become a practice facilitator at Barnet PCT so she could hone her IT skills and then became a practice manager again when she joined East Finchley five years ago
february 2013 25
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52