Across England, practices are witnessing an unprecedented acceleration in patient list cleansing. What might appear to be a routine administrative exercise has rapidly become one of the most significant financial and operational challenges facing general practice this year.
Over the past six months alone, GP practice lists have fallen by 344,000 patients. At current Global Sum rates, that represents more than £40 million removed from core general practice funding at a time when practices are already operating on razor-thin margins.
As Dr Helen Salisbury recently observed in the BMJ, “While no one argues that practices should be funded for patients who have genuinely moved away, the consequences of large-scale list reductions cannot be ignored. These deductions translate directly into lost clinical capacity, reduced staffing flexibility and increased financial instability.”
The current exercise differs from previous list validation programmes in both scale and speed. Writing to Primary Care Minister Stephen Kinnock last week, GPCE have expressed serious concerns that patients are now being given just three months to respond before removal, rather than the six months traditionally allowed. The result is not only a more abrupt financial shock for practices, but also a heightened risk that vulnerable patients are incorrectly removed from their registered GP.
Those most likely to be affected are often those least able to navigate administrative processes: older people, #patients with learning disabilities, those with limited English proficiency, and individuals with unstable housing arrangements. Many may never receive correspondence, may mistake it for a scam, or simply fail to appreciate the consequences of not responding. Meanwhile, practices are having to scrutinise hundreds of proposed deductions, creating a substantial additional administrative burden. Time and resources that should be focused on patient care are instead being diverted into checking lists and attempting to prevent inappropriate removals.
The profession is entitled to ask some difficult questions. What assessment was undertaken of the impact on vulnerable patients and health inequalities before this programme was accelerated? Why was the response period shortened? And perhaps most importantly, where is the funding going? The money removed through list cleansing is core GMS funding. If patient lists are being corrected, then the corresponding resources should be transparently recycled back into Global Sum so that funding continues to follow patient need. Yet GPC England has received little clarity about whether these savings will be reinvested in general practice.
Accurate patient data matters, but so does patient safety, practice stability and public trust. At a time when general practice is being asked to deliver more than ever with finite resources, list cleansing cannot become a backdoor mechanism for reducing investment in frontline care. GPCE will continue to press for urgent discussions with government and NHS England on the impact of this exercise and to seek assurances that both patients and practices are protected from unintended harm.
Read the ‘focus on’ guidance on patient list cleansing
Read about the 26/27 contract changes and the BMA dispute with Government
Also see our guidance on FP69/Practice List Cleansing/Revalidation/Ghost Patients