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Patients in England who have not been to see their GP for five years face being deregistered as the NHS prepares to get tough on "ghost patients".

NHS England said new rules would be brought in next month and see patients removed from GP lists unless they responded to warning letters.

The move is aimed at stopping GPs being paid for patients who have died, moved practices or left the country - up to 5% of practice lists could be wrong.

But doctors are worried about the plan.

The British Medical Association said people could be unfairly penalised as they might not respond to the letters and should "not be punished for being well".

To date it has been up to local areas to come up with their own ways of keeping lists up to date.

A variety of approaches is used, including following up people who do not respond to screening and immunisation requests and regularly checking on some patients - those who are elderly, students or have moved to England from abroad - when they have not been seen recently.

Some areas, including the east of England, have used similar techniques to the one now being rolled out nationally.

Saving money

In recent years there has been a renewed push after NHS England highlighted it as an issue that needed tackling back in 2013.

But as local areas have used more aggressive techniques, reports have emerged of patients being incorrectly deregistered.

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The new system - uncovered by GP magazine Pulse - will be administered by the private firm Capita, which signed a contract last year.

Patients will be sent letters when they have not seen their GP for five years. If they do not respond, a second letter will be sent and if that is not answered the patient will be deregistered.

A patient then wanting to get back on a list would have to reapply through the normal process.

GPs are paid a basic amount for each patient they have registered on their list - even if they do not see them. It can vary from place to place, but in 2013-14 it was worth £136 per patient on average.

The rest of their pay is then determined by what treatments they provide.

It is unclear how many patients are incorrectly registered. An exercise in 2009-10 identified 95,000 patients who needed to be removed, saving the NHS £6.1m at the time.

In 2012-13 NHS bosses estimated as many as 5% of the GP register population might be wrong.

NHS England said the move was important to ensure the "proper stewardship of public funds".

But Dr Richard Vautrey of the British Medical Association said he was concerned the national programme could lead to problems.

"Patients should not be punished for being well. No-one knows, no matter how well they are, when they will need their GP.

"NHS England needs to think again about the potential negative impact on patient access and the additional implications for practices, who could find themselves in situations of conflict between understandably angry patients who blame the practice for removing them from their list, when the fault lies with wider NHS management systems."

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