Over 300,000 patients have been stripped away from GP practices across England in the last year as part of what the BMA describes as NHS England’s 'aggressive' national patient list cleansing exercise. 

The Association believes the action is leaving patients without a GP and placing an even greater financial burden on practices. 

‘List cleansing’ is a routine data audit intended to find ‘ghost patients;’ for example, those who may have died, or have moved away. Letters are sent to suspected ‘ghost patients’ asking them to confirm they still wish to be a registered patient.  

The BMA’s GP committee for England is alarmed at the speed at which this list cleansing is happening and is challenging the veracity of the process being used by Primary Care Support England – the support body for GP practices, dentists and optometrists.

This accelerated speed is causing real patients to be mistakenly removed from their GP’s list, which is a threat to their safety. Many practices have already told the BMA that once they challenged these errors, the patients had to be added back onto their lists. This raises questions about the effectiveness of this audit process and why those patients were removed in the first place.

Additionally, suddenly losing patients means practices are facing unpredictable drops in funding. The instability is penalising practices that are already severely underfunded by the NHS ‘per patient’ system which is supposed to cover the baseline costs of delivering essential medical services (currently equivalent to just 36p per patient per day)

The BMA's GP committee deputy chair Dr David Wrigley said:

“This aggressive ‘list cleansing’ exercise has reduced GP practice patient lists by over 300,000 over the past 12 months, equating to practices losing just under £40 million in funding for essential GP medical services. This comes at a time when practices in England are already severely underfunded.

“A programme of this scale affects both patients and practices. While accurate patient lists are essential for planning and fair allocation of NHS resources, the pace and intensity of this exercise mean we cannot be sure that mistakes are not being made and patients being wrongly taken off their GP list.  

“Patients may be wrongly removed from their local practice if they do not reply to letters within the required timeframe. This risk is greatest for vulnerable patient groups, including older people, those with learning disabilities, those living in houses of multiple occupancy and individuals whose first language is not English. Such removals could seriously disrupt their care, and also requires practice teams to spend significant time reviewing cases to prevent patients coming to harm. These patients are also more likely to end up attending a local hospital emergency department, where one visit costs that NHS more than the GP practice receives for a whole year for one patient’s care.  

“For practices, the financial impact is considerable. In some areas, list reductions are leading to losses of tens of thousands of pounds in investment - funding that supports day-to-day operations and service delivery, and which practices have already factored into their financial planning (currently equivalent to just 36p per patient per day). 

“We also have grave concerns about where this ‘saved’ money is actually going. Instead of being put back into the main NHS funding pot to be shared out fairly among surgeries based on their actual workload, this core funding is being siphoned off for reasons that remain completely unclear. As this is core GP funding, the profession rightfully expects it to be reinvested straight back into local practices.  

“The problems this has caused are exactly why we urgently need a completely overhauled national GP contract and proper investment. The government have promised a new GP contract in England for two years now, but there has been no movement on this at all. GPs are naturally viewing this situation with growing dismay and are questioning NHSE and the Government’s motives and intentions. We don’t expect to be paid for services that aren’t delivered, but, given the national funding pot is already insufficient, if the bulk of our funding is reliant on list sizes – which are being reduced – then investment for the essential care patients require needs to dramatically increase.”

Ends

Notes to editors

Interviews:

Interviews can be arranged with a BMA GPC officer and / or a London-based GP practice who can speak (anonymously) about how this is impacting the practice and its patients.  

Background information:

There are several reasons as to why a patient might be considered inactive or removed, this includes: 

• Delay responding to letters  
• Incorrect correspondence address  
• Language barriers 
• Vulnerable, elderly, homeless, or transient patient group (i.e. students) 

The figure regarding the 300,000 patients being stripped from GP practices is based on NHSE’s national dataset, looking at the period of June 2025 to June 2026. 

About the BMA:

BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

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