NHS England patient list ‘cleansing’ costs GP practices over £30k on average, LMC warns

Exclusive GP practices in one area are losing £31,000 on average due to NHS England ‘cleansing’ patient lists, a process which seems to have affected deprived practices the most, a large LMC has warned. 

Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs said that the exercise, whereby thousands of patients have been deducted from GP practices’ lists, has created an ‘unexpected and disproportionate’ loss of funding which posed an ‘existential threat’ to GP practices, and it will ‘inevitably pose a risk of harm’ to vulnerable patients. 

The LMCs warned that practices worse hit seem to be in areas of high deprivation, particularly those practices who serve homeless patients, and said that patients will be distressed at being suddenly deregistered, and potentially come to harm through loss of follow up and recall systems. 

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 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’.

But the LMC said that there seemed to be ‘no obvious valid methodology’ to how patients are being selected for deduction as part of this process.

In a letter, seen by Pulse, the LMC told GPs that from its analysis of the NHS Digital data for every practice in the area, it found more than two-thirds (67%) of practices were affected, with the worst-affected practice losing more than 13% of its practice list (see box).

The letter said: ‘In addition to the clear and, in many cases, existential threat to practices from such an unexpected and disproportionate loss of funding, there are clear patient safety concerns around what NHS England is doing.  

‘There are many reasons patients may not respond to a request for confirmation of address, such as vulnerability, dementia, mental illness, and domestic abuse. There seems to be no obvious valid methodology to how patients are being selected for deduction. Such an opaque and aggressive approach to list verification will inevitably pose a risk of harm to our most vulnerable patients.  

‘Indeed, the data we have gathered shows that the worst affected practices are those in areas of higher deprivation. Furthermore, there is a risk patients will be lost to chronic disease follow up, recall, and screening programmes, further worsening health inequalities.’ 

The LMC said this has been accompanied by ‘a far more aggressive approach to issuing FP69 flags’ from NHS England. 

This has directly impacted practice finances because the global sum is tied to patient list sizes which are updated every quarter, the LMC said. 

‘As Global Sum is updated according to list size every quarter (the same time window as an FP69) and other capitated funding streams are pegged to the list as at 1st January, contractors may not notice patients have been deducted until they see a precipitous drop in funding at the next quarter, by which time it is too late to reverse what has happened’, the LMC said. 

The LMC urged GP practices to review which patients had been automatically deducted from their lists in the last six months and, where applicable, ‘challenge directly’ NHS England.  

The letter also advised practices to document patient safety concerns arising from this exercise, for the LMC to gather and submit as a formal complaint to NHS England. 

The LMC has called for ‘any and all funding lost from a practice by way of this process to be restored to the core funding of the practice from which it was lost’. 

BBO LMCs chief executive Dr Matt Mayer told Pulse: ‘I don’t think anyone for one second believes that this is simply a data accuracy exercise by NHSE; graphs don’t suddenly plummet like that unless the situation is being manipulated. This looks like a cynical attempt to defund and destabilise vulnerable practices by stealth. 

‘This is absolutely existential for practices, many of whom will have no idea that this has been happening for the past six months, and will first notice the gravity of the situation when they see their income inexplicably plummet at the change of financial quarter. 

‘Our data shows that the majority of practices are losing tens of thousands, and in some cases, hundreds of thousands of pounds. 

‘And this is harmful for patients too. Those practices worse hit seem to be in areas of high deprivation, particularly those practices who serve homeless patients. Vulnerable patients will be rightly distressed at being suddenly deregistered, and potentially come to harm through loss of follow up and recall systems. 

‘The Government need to urgently halt this entire exercise before the damage becomes irreversible.’ 

The letter said that the LMCs had ‘written to GPCE leadership’ about the issue.

GPC England chair Dr Katie Bramall said that as part of this exercise a London practice had ‘10% of its list removed’.

She told Pulse: ‘Practices rely on accurate information being received and shared between Primary Care Support England – who contract with NHS England – to ensure ongoing list validation. But 344,000 patients have been removed from their GP surgeries in the past six months alone.

‘Particularly hard hit have been practices in areas of deprivation, whose populations may be less stable. Student areas and areas with more active migrant populations are also being targeted. A London practice has had 10% of its entire list removed.

‘This is incredibly damaging to the viability of those practices who rely on the modest income of patients less likely to attend to subsidise the care of those patients whose needs mean they have very frequent and intense input. The Government say they are committed to social equity, but this drive appears to undermine their own policy positions and put patient services at risk.’

She added that this ‘represents a false economy’ for the taxpayer.

She said: ‘GPs are paid £130.07 per patient per year for essential services per patient. That’s just under 36p per patient per day in England. Less than the cost of an apple. A de-registered patient without a GP who attends their local A&E just once will cost well above a whole year’s GP payments.

‘The GP practice contract only buys 2.7 – 3.6 appointments per year per patient, but we know from various studies the average is far higher than this, with some suggesting it’s around 9.

‘This means the Government does not fund practices sufficiently to meet the demand across the population. Even without ‘list cleansing’, practices are barely staying afloat.

‘That’s why we believe investment and renewal of the GMS contract is so urgent. There simply isn’t enough money in the national global sum to distribute sufficient resources to all practices in England.’

An NHS England spokesperson said: ‘It is important that funding follows patients, rather than practices receiving money for patients no longer registered.

‘We 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 Capita for comment.