Scenario
Duplicate NHS numbers where allocated when registering a patient who had recently moved. Instead of verifying the existing NHS number on the Personal Demographics Service (PDS), a new registration was initiated, resulting in the patient being allocated a second NHS number.
Consequences
- Clinical Risk:
The patient’s medical history was divided across two records. This led to incorrect prescriptions and delayed referrals because clinicians were unaware of the full medical background. - Safeguarding Impact:
In one real case, the duplicate allowed a parent to move children without social services being alerted, as safeguarding flags were linked to the original NHS number. - Operational and Financial Impact:
GP practice payments were inflated because the patient appeared twice on GP lists, diverting funds from other NHS services. PCSE had to conduct an incident investigation and allocate extra resources to resolve the issue.
Resolution
- PCSE confirmed both NHS numbers related to the same patient and logged a merge request with the National Back Office (NBO).
- Once merged, PCSE notified the practice of the correct NHS number and instructed them to consolidate records in their clinical system.
Lessons Learned
- Some patients’ arriving from overseas may be allocated NHS numbers by the Home Office before they register with a practice.
- Always search PDS thoroughly to verify the patients’ demographic details before submitting a registration:
- Ensure multiple identifiers are verified before selecting a record from the PDS.
- Use NHS Smartcards and check address history, previous GP, and postcode.
- Train administration staff on the risks of demographic matching errors. Ensure staff are trained to recognise potential duplicates and escalate to PCSE rather than creating a new record.
- Understand the wider impact: duplicates compromise patient safety and increase unnecessary burden across the NHS.