Recent media headlines have highlighted that the NHS has an issue with ‘ghost patients’. This is when more people are registered with General Practitioner (GP) practices than there are in the population – the idea that millions of outdated patient registrations clog the system, costing resources and impacting care, or as insinuated in certain parts of the media, that GPs are ‘boosting their coffers’ (spoiler alert: there is no evidence to support this claim). While the headlines sound concerning and the rising number of ‘ghost patients’ is undeniable, there’s nothing sinister going on – rather it is a symptom of a broader set of issues.
Three reasons why the NHS has 'ghost patients'
Let's take a look at exactly why the NHS has ghost patients. As we see it, there are three key reasons. These are:
1. Dependency on fragmented processes and outdated technology. The first reason lies within the broader system for registering patients at GP practices. While it’s important to acknowledge that the current NHS GP registration system was a big step change when it was first introduced, it still depends on fragmented processes designed decades ago, outdated technology and manual workarounds. This has created a web of inefficiencies that burden practices and hinder the accuracy of patient data.
2. Evolving user requirements and expectations. Organizations struggle to keep up with constant change and shifting user expectations. By leveraging product thinking, organizations can identify and prioritize the right product investments to solve user problems holistically. NHS products have improved, but the great work being done by their product teams nationally and locally needs better support to deliver outcomes that will give the best results for the patient and practice. Without this, there will be an accumulation of workarounds, hindering the ability to adapt to evolving user requirements and expectations.
3. Challenges getting sponsorship and investment. The third reason is that getting the necessary sponsorship and investment through policy teams for this much needed work can be challenging, especially when you're competing with new policy initiatives while managing the NHS's continuing financial pressures.
Why does the system struggle?
When we say ‘NHS registration system’, it's worth noting that it's not actually just one system. It's really a collection of manual and sequenced updates across multiple national and local Electronic Health Record (EHR) systems used by GP practices. Each of these systems are independent from one another and do many different things. It’s no surprise that this tangled web is going to impact efficiency and accuracy.
One area of concern is the complexity of the registration process. Multiple manual steps and data entry points contribute to an unnecessary administrative burden for practices, which diverts valuable time and resources away from direct patient care. Fragmented processes also lead to inconsistent and inaccurate patient data, which further adds to the administrative workload.
The ‘ghost patient’ issue exemplifies this challenge. Outdated registrations persist in the system but de-registering these patients can be cumbersome and time consuming. Often, the process requires manual intervention which, in turn, is prone to human error. Poor user experience design (not the practice staffs’ fault!) further compounds the issue.
Keeping pace with patient changes
The current system struggles to keep pace with shifting patient circumstances and data timeliness. Patients move frequently; often they neglect to inform their registered practice (understandably so), which leaves the GP in the dark until the patient needs a prescription or visits accident and emergency elsewhere.
For the latter example, the GP will receive a hospital report with updated address information without knowing that there’s been a permanent address change. Even minor updates like a different phone number can slip through the cracks, leading to a potential communication breakdown.
These issues can directly impact the quality and continuity of care, underscoring the need for a more agile and responsive patient registration system.
The good news is that these problems are solvable and the current challenges can be overcome.
Opportunities for a better user experience
Let’s imagine a future where patient registration is truly patient-centric and where data flows seamlessly, free from errors and is available in real-time.
Patients effortlessly choose their GP, register and visit different practices with up-to-date personal data. They manage their own information and get instant feedback when changes are made. Patients receive timely reminders and no longer need to fill in clunky forms or wait weeks for confirmation.
Practice staff no longer need to enter data (in total there are currently more than six million patient registration events every year) but nevertheless still control the size of their list; the system handles all updates, and sends clear communications to patients which frees up valuable time to deliver direct patient care.
The wider NHS service is healthier, more efficient and costs less. Accurate, up-to-date patient information flows effortlessly, eliminating the ‘ghost patient’ problem with resources allocated more effectively and transitions between care providers running much more smoothly.
This user-centric, efficient and connected healthcare landscape could be in the near future for patients.
How can a product thinking approach make this happen?
Getting to this world will be challenging. However, product thinking could be a particularly helpful tool for helping us get there.
Understand the problem holistically: View patient registration as a user journey made up of connected experiences that need to be optimized across all touch points.
Prioritize and focus on meaningful outcomes: Identify critical user needs and pain points, and direct delivery teams to achieve specific, measurable outcomes. For example, reducing the administrative burden for practices.
Iterate and improve: Treat patient registration as a product that evolves based on data, feedback and changing user needs.
A commitment to delivering high-quality care
NHS England has made a great start by introducing the patient-facing ‘Register with a GP service’ that's already delivering benefits and improving the speed and accuracy of registrations.
Another example is the initiative by Thoughtworks and the NHS to improve the NHS’ GP2GP patient record transfer system that led to an 84% reduction in technical failures and far fewer records needing to be printed and transferred manually. Both demonstrate a commitment to improving the patient experience, reducing admin workloads and delivering high-quality care.
With this foundation and further funding, the NHS is well-placed to streamline backstage workflows, automate data updates with robust data validation and simplifying de-registration processes to significantly reduce admin workloads.
Creating better outcomes
Modernizing patient registrations is not just about administrative efficiency and productivity gains, it's about empowering healthcare providers to deliver the best possible care for their patients. By addressing the current challenges and embracing innovative solutions, we can create a more streamlined, accurate, and patient-focused registration system that supports the NHS in its vital mission.
The change we outlined here, relies on taking a product thinking approach, connecting problems, breaking down the barriers between systems and workarounds to focus on better outcomes for both patients and clinicians.
Disclaimer: The statements and opinions expressed in this article are those of the author(s) and do not necessarily reflect the positions of Thoughtworks.
