LMCs demand parliamentary investigation into NHS England GP list 'cleansing'

Exclusive A group of LMCs has demanded a parliamentary investigation into how a GP list cleansing process, currently being carried out by NHS England and expected to cost practices millions of pounds, has been approved.

Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs demanded an investigation by the parliamentary health and social care committee, including what equality impact assessments were conducted, considering ‘the disproportionate effect on ethnic minorities and vulnerable groups’.

Separately, the LMC Support Network wrote to the health secretary and NHS England demanding a pause of the exercise and a published methodology underpinning it. The letter was signed by 74 LMCs across England.

BBO LMCs warned last month that GP practices in there area were losing £31,000 on average due to the process, which seemed to have affected deprived practices the most.

Their updated analysis on how much the process is going to cost practices, seen by Pulse, revealed that the total annual projected capitated funding loss in their area would be £19.1m.

The scale of the list-cleansing problem

A total of 110 practices responded with their data, which represents a turnout of 51.2% of all the constituent practices of BBOLMCs.

Proportion of respondents with increase in FP69s – 92.7%
Average increase in FP69s issued since last year – 311%
Proportion of practices where FP69 demographics were not representative of their patient population – 71.2%
Total annual projected capitated funding loss (BBOLMCs) – £19.1 million
Estimated funding loss per remaining registered patient – £6.73
Projected capitated funding loss if scaled up to all England -£425.1 million

Source: BBOLMCs analysis shared with Pulse

The LMCs added that no further list cleansing should be undertaken until reforms to the Carr-Hill formula for GP funding have been completed.

They echoed the BMA’s demand that funding ‘saved’ through this process to be reimbursed directly to those practices from which it was lost to ‘ensure no detriment to vulnerable populations or widening of health inequalities’.

The union had previously asked for ‘urgent discussions’ with the Government over the issue.

BBO LMCs added that there is ‘a real human cost to patient safety’ being reported by practices.

They said: ‘Firstly, some practices are reporting a significant number of patients being deducted with absolutely no justification, who then needed to be re-registered, with understandable distress.

‘Secondly, and just as concerning, is the number of practices who reported that the patients being deducted were not representative of their registered list demographics, 71.2%.

‘Practices with predominantly ethnically white British populations, reported a disproportionate number of non-white patients being deducted, with three quarters reporting an over-representation of ethnic minorities and migrants.’

What practices should do

Immediately determine your current list size and which patients have been automatically deducted over the past six months by way of the FP69 process. Where a patient has been inappropriately deducted, the deduction can be challenged directly to NHS England or the patient re-registered depending on the circumstances, as laid out in NHS England’s own processes.
Ensure the appropriate responsible person in your practice (e.g. Practice Manager) is actively monitoring inbound FP69 flags on a very regular basis and prioritising them for review. Assume all FP69 flags are questionable in their validity and challenge each and every flag according to the processes set out by NHS England.
Document any patient safety concerns which have arisen as a result of this process so that these may be later submitted by the LMC as part of a formal complaint to NHS England for Significant Event Analysis. Such events may include:
a. Vulnerable patients losing access to their surgery
b. Loss of continuity if a patient is inappropriately deducted
c. Failure of chronic disease, cancer, or screening follow up
d. Deterioration of patients with mental health problems

Source: BBO analysis shared with Pulse

BBO LMCs said: ‘Overall, on top of the already grim financial picture for 2026/27, practices will certainly find themselves in a net worse position, even before inflation, compared to where they were in 2023.

‘Whilst NHSE may argue that practices should not be being paid for patients who don’t exist, this process cannot be safely or fairly conducted unless and until the anachronistic Carr-Hill formula is reformed.

‘The Government has apparently expressed a commitment to reform Carr-Hill, and it is grossly cynical to carry out such aggressive list cleansing before that process has completed.’

BBO chief executive Dr Matt Mayer told Pulse that it was ‘reckless’ to commence list cleansing ‘on such a massive and accelerated scale’, before correcting the Carr-Hill formula.

He said: ‘Not only are practices now facing existential financial losses, without warning, but there is a significant risk of patient harm, particularly vulnerable patients and minority groups.

‘This process needs to be immediately paused pending an urgent investigation in to how this process was approved, what impact assessments were done, and whether the BMA agreed to this process.’

Typically, when NHS England believes a patient should be deducted from their practice list, they write to the patient and request them to confirm their registration within 30 days. If the patient does not respond, NHS England applies a flag (FP69) to the patient record. The practice would then have six months to confirm the patient’s identity, or the patient would be automatically removed.

However, due to an amendment in the GMS contract last year, since October 2025 the timeframe for practices to respond is now just three months.

NHS Digital data showed that 458,188 patients have been removed from practices’ lists in England since October last year.

Patient list sizes are part of the global sum funding allocation formula, meaning reductions in lists leads to a reduction in funding.

NHS England previously told Pulse that they are assessing the ‘likely impact’ on individual practices where patient lists ‘may be significantly inflated by patients no longer thought to be resident in the area’ and support will be offered by ICBs and NHS England to practices ‘mitigating any impact’.

Pulse has contacted the Department of Health and Social Care and NHS England for comment.