Five million “ghost patients” are inflating GP practice lists and costing the NHS hundreds of millions of pounds a year, an Oxford University health expert has warned, as he called for the system to be dragged out of the paper-records era.
Figures show approximately 63.4 million patients are registered with GP practices in England, despite the country’s population standing at 58.6 million. The gap of nearly five million means practices are receiving around £130 for each registered patient annually — an estimated £650 million extra that may be following people who have died, moved home, relocated for work, gone to university, or emigrated.
The discrepancy is not new. Research indicates the number of so-called ghost patients has been widening for years: there were around 3.6 million in 2018, rising to 5.8 million by November 2023. In 2022-23 alone, practices could have received about £955 million for non-existent patients based on an average payment of £164.64 per registered patient.
Professor Carl Heneghan, director of the Centre for Evidence-Based Medicine at Oxford University and an urgent care GP, said the problem was a symptom of a primary care model designed decades ago when records were held on paper and most patients remained with the same family doctor for years. “The system was set up in the days when there were paper records and this is no longer appropriate,” he said. “Students go home in the summer, people move regularly for work and you should be able to go to the GP where you want.”
He argued that the current registration system struggles to cope with modern life because it relies on manual steps and multiple data entry points across a patchwork of electronic health record systems that often cannot communicate with each other. Patients may not always inform their registered practice of address changes, and the fragmented IT infrastructure — developed by different organisations over many decades — means there is no automatic way to update records when someone moves.
“It is a symptom of a failing system and if this was a private company it wouldn’t tolerate this level of dysfunctionality together with huge waiting lists,” Professor Heneghan said. “Which business would tolerate this?”
An unnamed NHS advisor echoed the criticism, describing the technology used by the health service as “as advanced as the abacus and the printing press”. They said digital progress should be a priority “because the failings in the system are costing money and ultimately costing lives when patients are not followed up properly”.
A system in need of radical reform
Professor Heneghan believes the answer lies not in repeated administrative exercises but in modernising the way primary care works. He wants patients to be able to access routine care wherever is most convenient rather than being tied to a single surgery. “If a patient needs an appointment, they don’t necessarily need to see a specific GP, and GPs can access each other’s GP records now,” he said. “It’s like taking your car to a garage for an MOT. You shouldn’t have to go to a specific garage. All the details should be on the system and the money should follow the patient.”
He pointed out that A&E departments already operate on this basis — patients are not turned away because they are registered elsewhere. “This is not what happens if you turn up to A&E. You don’t get told to go back to your local A&E where you live. If we are to be putting the patient first this is what we should be doing,” he added.
Successive governments have spent billions trying to modernise NHS technology. The NHS App has become the digital front door for millions, and ministers are pursuing plans for a future Single Patient Record (SPR) — a single, secure digital record that would consolidate a patient’s medical history, test results, treatments and prescriptions into one accessible place. New legislation expected to be debated in Parliament on 1 June 2026 will mandate healthcare providers to share patient data for the SPR. Proponents say it could reduce medication errors and duplicate prescribing, potentially saving over £20 million annually, as well as preventing up to 20,000 A&E visits per year and freeing around 500,000 hours of clinicians’ time.
Yet experts caution that the SPR is an attempt to connect and scale existing infrastructure rather than replace it. Significant challenges remain around public confidence, data governance, safeguards and technical delivery. The British Medical Association (BMA) has expressed concerns about GP data remaining in the SPR, advocating for doctors to retain control as “data controllers”.
BMA warns of aggressive ‘list cleansing’
The BMA has accused NHS England of carrying out an increasingly aggressive “list cleansing” exercise — a process intended to identify deceased or relocated patients — which it says risks removing genuine patients from GP lists. The union claims surgeries are now being instructed to remove patients if they fail to respond to letters or other contact attempts within three months, rather than the previous six-month period.
Dr Chand Nagpaul, a GP and former chair of the council of the BMA, warned that older people, those with learning disabilities, people living in houses of multiple occupancy, and patients whose first language is not English could be particularly vulnerable if they fail to respond in time. “There is a high risk genuine patients are being removed by mistake,” he said.
GP leaders estimate the accelerated process has already reduced practice lists by more than 300,000 patients over the past year, costing surgeries nearly £40 million in lost funding. The BMA has questioned where the money saved from the exercise is being redirected, arguing it should be reinvested into the global sum funding for surgeries. Practices receive a set amount per patient — in 2025-26 the global sum payment per weighted patient increased from £121.79 to £123.34 — and any loss of registered patients can destabilise a surgery, particularly in areas of high deprivation where the outdated Carr-Hill formula used to distribute funding already disadvantages poorer communities.
An NHS England spokesman defended the process, saying: “It is important that funding follows patients, rather than practices receiving money for patients no longer registered or living in England. NHS England has always worked with GP practices to regularly review their lists and improve their accuracy, with robust checks to ensure people are not removed inappropriately and patients contacted before any action is taken — ensuring money and staff time is not wasted on activity like unnecessary vaccination recalls.”