NHS patient registers in England currently include nearly five million more individuals than the actual population, leading to significant financial implications for the health service. NHS data shows that 63.4 million patients are registered with general practitioner (GP) practices, despite England’s population being approximately 58.6 million. Since GP practices receive about £130 annually per registered patient, this discrepancy results in around £650 million in additional funding being paid for so-called “ghost patients” who either have died or moved away without their records being updated.
The issue has drawn criticism from political figures and healthcare professionals alike. Stuart Andrew, the shadow health secretary, attributed the problem to outdated systems, saying that reliance on paper records and fragmented technology hampers efforts to reduce administrative waste. He warned that without improved IT infrastructure, millions of pounds will continue to flow unnecessarily.
Efforts to address inflated patient lists typically involve “list cleansing,” a process where GP practices audit their registers and contact patients who may no longer be registered through letters. However, the British Medical Association (BMA) cautioned that recent attempts to update lists have been overly aggressive, resulting in the inadvertent removal of some genuine patients. These individuals, often vulnerable or less able to respond quickly to communications, may have missed important health reminders, such as those for screenings or vaccinations. The BMA reported a reduction of about 300,000 patients from GP lists during 2025, removing around £40 million in funding from practices already facing financial strain.
Dr. David Wrigley, deputy chairman of the BMA’s GP committee, highlighted concerns over the shorter response deadlines imposed. Traditionally, patients had up to six months to confirm registration; this timeframe has been shortened to three months, increasing the risk of mistakenly deleting patients who merely failed to respond promptly. The union did not provide an exact number of wrongful removals but emphasized the potential impact on both patient care and administrative workload, especially among groups such as older people, individuals with learning disabilities, those in shared housing, and non-English speakers.
Historically, NHS England has instructed practices to regularly review patient lists to reflect accurate populations and ensure appropriate funding distribution. However, while population numbers increased by about three million between 2017 and 2025, registered patient counts grew by nearly five million during the same period, widening the gap. This marks the first decline in patient lists recorded in at least seven years.
NHS England stated that it works closely with GP practices to verify patient lists with “robust checks” aimed at preventing improper removals and ensuring efficient use of resources. The BMA acknowledged the necessity of accurate patient data for resource planning but stressed that the current intensity of list cleansing risks patient safety and could place further burdens on already underfunded practices. The union plans to advocate for increased funding and improved systems at its upcoming annual meeting, where healthcare professionals will seek support to address ongoing financial and operational challenges faced by GPs.