An NHS policy to remove “ghost patients” from GP lists is inadvertently leaving some of the poorest people in England without vital healthcare, analysis has found.
Under previous NHS rules, inactive patients at risk of being removed from their GP practice were given six months to respond to outreach. But under NHS England’s accelerated list validation timeline, introduced last October, patients now have only three months to reply.
According to analysis by Healthtech-۱, registered GP lists in English practices declined by ۴۸۳,۰۱۹ patients between October ۲۰۲۵ and July ۲۰۲۶, with the most deprived fifth of practices accounting for about ۱۳۸,۴۰۰ of the net decline – just under ۳۰% of the national decline.
While GP lists need reviewing as people move away or die, GPs have said the accelerated timeline has inadvertently led to patients from deprived areas being incorrectly removed, creating barriers to receiving treatment.
Consequently, GPs and practice managers have reported having to re-register vulnerable and elderly patients, creating an additional administrative burden.
De-registering patients can also cause gaps in care and disruption to treatment. Since GP practices’ income also depend on the number of registered patients, a drop can leave practices struggling to pay for running costs.
A GP at a university practice in Southampton said the accelerated timeline was causing problems because patients were being incorrectly removed from their list and were struggling to access their prescriptions and treatment.
“If you give prescriptions out to people, they’re on repeat and once they get kicked off the lists they can no longer access any prescriptions,” he said. “The risk is that if you’re unable to access your repeat prescriptions, your treatment will be affected.”
He added: “If you’re narrowing the window from six to three months, more people are going to be kicked off and therefore more people will be put into the position where they cannot access treatment.”
The GP also warned that, besides reducing a practice’s income, the policy change was hitting patients from deprived and vulnerable backgrounds hardest.
“In our case, we had around ۱۰۰ people who were taken off our list who didn’t leave at all. That worked out as around £۱۰,۰۰۰ in lost income for our practice,” he said.
“We were later contacted by these patients telling us that they couldn’t access their prescriptions and that they hadn’t gone anywhere.
“The money we’ve lost hasn’t been compensated, and I know of another practice locally that has lost £۱۰۰,۰۰۰ that they also won’t be compensated for.
“For those who have been erroneously taken off, we’re being penalised. We’re going to have to make cuts somehow to make up the shortfalls.”
Dr Clare Bannon, the chair of the British Medical Association’s GP committee, said GPs across England support the principle of keeping patient lists accurate but the current list-cleansing process is “seriously flawed”.
Bannon said: “We have called on NHS England to pause the exercise. The approach is overly aggressive, leading to practices losing tens of thousands of pounds in income and causing active patients, including vulnerable individuals, to be removed in error.
“It is essential that active patients are not deprived of access to a GP through no fault of their own.”
An NHS spokesperson said: “There are robust checks in place to ensure that vulnerable groups are not removed from GP lists – people are contacted through multiple different channels with the thorough processes lasting up to five months before any action is taken.
“This process ensures that patient contact details are correct so that they receive vital information about screening and vaccination appointments, while ensuring NHS funding resources are allocated fairly with money no longer spent on people who do not live in England.”
