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New rules designed to drastically reduce the number of "ghost patients" registered with GPs in England could save the NHS more than £400M per year.

Some doctors have expressed concerns that genuine patients could be removed from their doctor's register if they haven't visited for five years. But that would only happen if those patients failed to respond to two letters asking if they still wish to be registered with their doctor. No-one will be removed automatically without attempts to contact them first.

Latest figures suggest there could be as many as three million "ghost patients" registered with GP practices in England. In March this year there were just over 57 million patients on GPs' books across the country, but data from official census records suggests the correct figure should be about 54 million.

The difference could be accounted for by patients who have died or left the country, but remain on doctors' books. Some of the three million could also be genuine patients who did not fill in the most recent census form, in 2011.

Having incorrect figures is a big problem for the NHS because it costs money which could be better spent elsewhere. GPs are paid a basic amount for each patient registered on their list, regardless of whether or not they see that patient. While the sum varies in different parts of the country, the average was £136 in 2013/14.

If the figure of three million ghost patients is correct, that could mean the NHS is wasting around £408M every year on patients who do not exist.

So far it has been left up to local areas to make sure their doctors' lists are up to date, with a variety of approaches used. Now the new rules are being rolled out across England, with the NHS hiring a private company, Capita, to carry out the project.

Under the rules, patients who have not seen their GP for five years will be sent a letter asking them to confirm that they still wish to be registered. If they fail to respond a second letter will be sent and if that also goes unanswered, only then will the patient be deregistered. A patient wanting to get back on the list would have to reapply through the normal process.

Some doctors have expressed concerns that the letter could upset some genuine patients who might feel they are being penalised for not being ill, but NHS England insists that genuine patients have nothing to fear. They need only respond to the letter, using a variety of quick and simple options, to ensure they remain registered with their doctor.

It is much more important, says NHS England, to have a true picture of the number of real patients on GPs' books. Only then will it be able to slash the amount of public money currently wasted on "ghost patients".

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