Wednesday, 12 June 2019

Lock 'em up and throw away the key...

From the BBC:

The NHS fraud squad is investigating GPs in England amid suspicions they are claiming for non-existent patients.

Doctors get an average of £150 a year for each patient on their list, but records show there were 3.6 million more patients in the system last year than there were people in England.

The discrepancy prompted NHS England to employ [Crapita] to start chasing up these so-called ghost patients.

The NHS Counter Fraud Authority is now launching its own investigation.


... in the following order

1. Whoever thought it was a good idea to pay each GP a quarter of a million quid a year in the first place. From the article:

The average GP has around 1,700 patients on their list so the payments make up a significant chunk of their income.

1,700 x £150 = £255,000, and that's just a 'significant chunk'. How much more do the buggers get?

2. Whoever thought it was a good idea to pay GP's on this basis (rather than work actually done).

3. Whoever let things slide for so long rather than crunching the numbers every year as a matter of routine.

4. Whoever thought it was a good idea to throw money at Crapita for doing something which the NHS Fraud Authority is (or should) be doing.

5. A few GPs and their chief receptionists who must have been complicit in the whole scam, pour encourager les autres.

8 comments:

Lola said...

FYI Some years ago I met one of the negotiators on the GP's side in their contract renegotiations with the Blair government. He told me that he went into the meeting and listened and listened and then asked if he could have a short break so that he could put the offer to his members committee. Blair's crew of course agreed. He told his member committee to, and I quote, 'bite their arms off'. He could not believe the ludicrously generous and stupid in other ways offer that Blair's crew had made. So he went back in and prevaricated and generally wasted time to make the pretence of 'negotiation' and eventually 'grudgingly' accepted the offer...

Mark Wadsworth said...

L, yes, New Labour threw money at them, GP incomes doubled from £50k to £100k within a year or two.

But the Tories have been in charge for nine years, and they've done some nasty cuts to welfare payments to keep the "hang 'em, flog 'em" brigade happy, but they've allowed GP incomes to more than double yet again, from a very high base.

The Stigler said...

1. What Lola said
2. I'm not sure per patient isn't a bad idea. Paying them for work just encourages them to do crap, pointless, high-value (to them) work.
3. The public sector is terrible at routine monitoring. It often takes a whole pile of crap before anyone goes and fixes it. The private sector generally tries not to let this happen. You work somewhere like Honda, they're tracking everything on a daily, weekly, monthly basis. If there's problems in the paint area, it's a known problem the next day. And people start investigating quickly.
4. The reason companies like Capita and Serco get used is that they get it done. It's a simple contract of work for a fee. The public sector isn't. Try firing someone in the public sector. It's almost impossible.

Bayard said...

TS, I am sure that paying them for work is a bad idea. This was how the NHS dentists were paid and is the reason my teeth are falling to bits, because my NHS dentist drilled and filled them, whether they needed it or not. After a few years he whipped all the fillings out and filled them again. Trouble was, I didn't realise what was going on until too late, although I did manage to keep my wisdom teeth, which my dentist was keen to remove, but purely on the "if it ain't broke, don't fix it" principle, not because I'd rumbled him.

Mark Wadsworth said...

TS, B:

2. When I said "Paying them for work done" I mean being available and seeing a minimum number of patients for X hours per day. GPs' work consists of telling people not to worry; handing out routine prescriptions; and diagnosing cases of "Fucking hell, this is serious" and shipping the patient off to a specialist. They're not supposed to actually carry out treatments (unlike Bayard's dentist).

3. Agreed, which is why the people in charge who could - but don't - put routine monitoring systems in place are on the list of people to be locked up and the key thrown away.

It's all so easy with databases and data mining, a programme can just run in the background, matching names, addresses, NI numbers, P60 details, electoral rolls etc.

At the end of every day, it spews out a list of people registered with more than one GP, or people on a GP list in Town A but whose P60 and electoral roll entry says they live/work in Town B a hundred miles away, or people on GP lists whose state pension stopped years ago because they are dead.

The fraud crack squad turns up at the surgery at 7 next morning, seals off the premises and has a good rummage.

A few arrests every year reported in "GP Weekly" and this will all stop.

Mark Wadsworth said...

.. to be honest, I was registered with a GP where I used to live, moved home and next time I was poorly, registered with the local GP. Did I take any steps to have myself taken off the old GP's list? Certainly not, it never occurred to me until now.

So the onus should also be on the new GP to contact the old one. Any GP who takes on a new patient without contacting the previous GP is also on the arrest list as being a passive accomplice in the scam.

The Stigler said...

"It's all so easy with databases and data mining, a programme can just run in the background, matching names, addresses, NI numbers, P60 details, electoral rolls etc.

At the end of every day, it spews out a list of people registered with more than one GP, or people on a GP list in Town A but whose P60 and electoral roll entry says they live/work in Town B a hundred miles away, or people on GP lists whose state pension stopped years ago because they are dead."

It's roughly that, but when you have shared databases, and things like regular jobs, there's a lot of infrastructure stuff to do. Instructions have to be raised for the job, processes around what happens if there's a failure, where will the results be placed. The change has to be reviewed in terms of impact on the current database.

In small places, most of this is done around a table with a cup of coffee. Takes 30 minutes and you do the work. In large places, there's not only a lot more people involved, but some of them are difficult buggers, and if they get difficult, escalation is a real problem. You work in a small place, you're maybe 3 levels down from CEO/owner. Worst case, you knock on his door, tell him Bob says he won't do X. He goes and walks down to see Bob, tells him to get on with it.

In large places, it takes longer. For you to get someone way down the other end of the company structure to do what you want, you may have to go way up the hierarchy of 7-8 levels of people. How long do you think that will take?

My own pet story from the NHS was about district nurses and sat navs. I did a business improvement job with a friend and the first thing was giving district nurses sat navs. This was so simple. Nurses were getting lost, give them nurses, they'll do more appointments. We crunched some numbers and reckoned they'd pay back in a few months. When we told someone this, they listed all the reasons nurses couldn't have them. It wasn't on the standard catalogue, so that would first take research selecting a sat nav that was suitable. Then assess suppliers. And both of these require mountains of paperwork from those people. Then take time having meetings to get them on the catalogue. They'd need to be trained in Sat Nav, and that process for that training agreed. The unions would have to be consulted about using sat navs as it wasn't a core skill for nurses. A policy would need to be agreed about storage or theft and replacement.

And the problem is that by the time you get through all this crap, your £250 Sat Nav is now a £10K Sat Nav, and it isn't worth doing. So small, gradual process improvement doesn't happen. You need a whopping great project with a huge budget (and that in itself takes an army of bureaucrats).

It's why provincial local authorities are not bad at process change compared to the rest of government. The number of people to agree things isn't that big. It doesn't have that many layers for escalation. Wiltshire Council is 10,000 employees in total. It's not that hard to get people to agree things. NHS England is 1.2 million employees.

Mark Wadsworth said...

TS, sure, but the system doesn't need to be 100%. Even if they only catch one offender in five, that will deter three out of the remaining four.

The police don't catch all criminals, but the significant possibility they will catch you acts as a good detergent.