- Some patients may use a totally false identity whereas others may just change their date of birth slightly or use a false address or a false story or 'legend' e.g. on holiday and left medication at home, going abroad for extended period, medication/prescription lost or stolen, relatives deceased or very ill
- False registrations may be temporary or permanent. The previous registration details provided are often false i.e. GP doesn't exist or patient never registered with them
- The types of drugs requested are normally benzodiazepines and/or opioid analgesics, often 'piggy-backed' onto more innocuous requests. The patient maybe very knowledgeable about the drugs they are requesting and know the contra-indications if less addictive drugs are offered as an alternative
- False registrants will normally request to be seen immediately and are unlikely to return for a new patient health check or further consultations, they will also normally fail to attend any referrals to secondary or specialist care
- Some prolific false registrants are well practised con-artists and therefore appear polite, confident and genuine. Appearance and manner cannot be used to judge whether patients are authentic, this can only be based on the evidence available (so the more evidence the better!)
- The advice is not to prescribe any benzodiazepines and/or opioid analgesics for new patients without reference to the previous GP, medical notes or the Clinical Application Spine. It is suggested that the patient be asked to take a seat in the waiting room or come back later whilst these enquiries are made. If the patient is not genuine they are unlikely to wait around or return.
- If this is not possible and prescribing is unavoidable, we would suggest that the patient only be given sufficient medication to allow their story to be checked i.e. 24 or 48 hours supply
- It is also advisable for all GP practices to request evidence of identity from all new patients before registering them.
- Please report suspected false registrations to their LCFS, giving as much detail as possible. The details of these patients can then be circulated and all related incidents can be collated by the Counter Fraud Service to identify serial offenders.
- Where false identities are used, alerts sent to GPs by the FHSA can only give the names known, so more attention should be paid to the drugs requested, story (legend) and description. Vehicle registration and mobile phone numbers are also very useful to tie incidents together.
NHS Counter fraud website http://www.nhsbsa.nhs.uk/377.aspx
Useful tips from Dr J Gallagher a GP in Southampton who has significant experience with drug abusers
May I also suggest giving diazepam as only 2mg tablets. The 10 mg tabs are much sought after and can command a premium of £2.50 each on a Friday night in St Mary's. There is a widely held belief amongst users that 5 x 2mg does not give the same "buzz". Also, Procyclidine is popular amongst teenagers and 15 can cause a confusional state with psychotic features for which there is no antidote.Symptoms can take 3-5 days to abate. Heminevrin (Chlormethiazole) is still recognised and has a street value. It is no longer used for an alcohol detox but those in the know will sell six for £2-3.00 knowing that these taken with two cans of strong lager puts you in cuckoo land for 18 hrs. A lot of sustained release morphine tablets still find their way onto the streets and there is an argument for never putting this on a repeat prescription. I know most doctors do not prescribe Buprenorphine (Temgesic,Subutex) but you may be interested to know that an 8mg Subutex tablet now commands a price of £80.00 in prisons where it is highly regarded for snorting and injecting. Happily, its successor, Suboxone (buprenorphine with Naloxone) does not attract the same attention and its street price is steady at £5.00 for an 8mg tablet,usually sold to a user suffering withdrawls. Dihydrocodeine 30mg fetch two for £1.50. I tend not to use sustained release versions of DHC. Fentanyl patches are cut into centmetre squares and sold at £1-2.00 each for sucking. Finally, you will find yourself under considerable pressure often late on a Friday from these patients who can be quite threatening. One gambit is to infer that you are already under police/drug squad scrutiny for an earlier event and that you might even be "put away" if a mistake is made. If you can keep a straight face and lay it on you can actually end up with them comforting you and offering condolences! (This has happened!) Good luck!
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